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Questionnaire Required for University FCC Biannual Ownership Report

In connection with the reporting requirements of the Federal Communication Commission (FCC), including the filing of the University’s Biannual Owners’ Report, the University is required to obtain certain information from its governing board members. So that we can ensure the University’s compliance with these FCC requirements, we ask that you please respond to this questionnaire by Monday, February 12, 2018.

Thank you for your prompt response, and please do not hesitate to call the Office of the General Counsel at 860.768.4275 if you have any questions or difficulties completing the questionnaire.

Personal Information

Name: *

Email: *

U.S. Citizenship: *

If No, Specify Country of Citizenship:

Hispanic or Latino Ethnicity: *

Race (check all that apply): *

Tribal Nation or Tribal Entity (check if applicable): *

Principal Profession or Occupation: *

Broadcast Questions

Question 1

Do you hold an attributable interest (equity, financial, or voting interest) in any other broadcast stations*?

1. Please Select: *

If yes, describe nature and size of any interest (ownership, governanace, employment or official relationship) you have in any other broadcast station.

1a. Interest Description:

Question 2

Has an adverse finding been made or final action been taken against you (or any other entity in which you have an attributable interest by FCC standards**) by any court or administrative body in a civil or criminal proceeding, brought under the provisions of any law relating to the following items.

2. Please Check All That Apply: *

Question 3

Have you been subject to a denial of Federal benefits by any Federal or State court pursuant to Section 5301 of the Anti-Drug Abuse Act of 1988?

3. Please Select: *

If you answered yes to question 2 and/or 3, attach a full description of the matters involved, including an identification of the court or administrative body, the proceeding (by dates and file numbers), and the disposition of the litigation. Use the file upload button below.

Please upload all documents as one file.

File Upload:

Question 4

Do you have an FCC Registration Number (FRN) or Restricted Use FRN (RUFRN)***?

4. Please Select: *

4a. If Yes, Enter FRN or RUFRN:

Question 5

Would you like the station to obtain a "Special Use FRN" for you from the FCC for the purpose of filing the required FCC Ownership Report?

5. Please Select: *

Note: We have been advised to recommend that you respond "Yes" – using the Special Use FRN whenever possible. The Special Use FRN does not require you to apply online for your own FRN, including entering personal information and Social Security Number information online. If "No," then you will need to obtain an FRN or RUFRN from the FCC (by entering such information) and provide it to the station to complete its ownership report.

* You have an attributable interest in another entity if you are an officer or director of the entity or if you own 5% or more of the stock or other ownership interest in the entity.

** You have an attributable interest in another entity if you are an officer or director of the entity or if you own 5% or more of the stock or other ownership interest in the entity; however, you only need report findings or actions if you control the entity or if you were directly involved in the reportable misconduct.

*** If you have indicated an attributable interest in a commercial broadcast station in response to that earlier question, you or the station have probably obtained an FRN or RUFRN.