Alpha Epsilon Pi Chapter of Phi Theta Kappa

Honor Society
Applicant Information
*Required for Membership

This information will be used by Phi Theta Kappa Headquarters to

secure transfer scholarships for Society Members and to design
effective chapter programming. Information will only be released to
senior institutions providing scholarship opportunities or other
organizations providing benefits exclusively for Phi Theta Kappa
members.

Please Type the Following:

*Required Field

First Name* Middle Initial Last Name* Student ID # or

SS #*

Area Code * Telephone Primary E-Mail* Secondary E-mail

Number*

Street Address* City* State* Zip Code*

Country* Major (see Majors Graduation Graduation Year*

List)* Month *

Total Credits Grade Point RVCC Student Eligible to Join

Average Since Since

-Note about the graduation month and year: If you do not plan to graduate
but to transfer, list the month and year when you will be transferring. If you
are uncertain please fill out to the best of your ability
  I will be attending the induction ceremony and plan to bring
_______ guests.
 I have joined the Phi Theta Kappa Groups on the Lions Den and
plan to check my email weekly for any updates
 I have read all of requirements for membership on the
Membership Application Process Page

Academic Majors Codes:

ACCT Accounting INFOTEC Information
Technology
AGRI Agricultural Sciences JOURNL Journalism/
Broadcasting
ARCH Architecture/Drafting LANG Languages
ART Art LEGAL Legal Services/
Paralegal
AVIAT Aviation LIBSCI Library/Info Science
BIO Biological Sciences LIBART Liberal Arts/ General
Sci
BUS Business LITER Literature
CHEM Chemistry MARKET Marketing
CHIRO Chiropractor Studies MATH Mathematics
COMM Communications MGMT Management
COUNC Counseling MEDTEC Mediucal Technology
CRIM Criminal Justice MIL Military Science
DENTAL Dental Health MORSCI Mortuary Science
ECOLO Ecology THEATER Theater/Music/Dance
ECON Economics NURS Nursing
EDUC Education/Teaching PHARM Pharmacy
ELEC Electronics PHYS Physics
CIVILENG Engineering Civil POLISCI Political Science
ELECENG Electrical Engineer LAW Pre-Law
MECHENG Engineer Mechanical MED Pre-Medicine
ENGL English PSYCH Psychology
ENVIRO Environment Studies ADV Public Relations/Ad
FASH Fashion/Merchandise RELIG Religion/ Bible
FIN Finance SOCIO Sociology/ Social
Science
FORSTUD Foreign Studies TRAVL Ravel/Tourism/ Htl
Man
SCI General Science VETMED Veterinary Medicine
HEALTH Health Professions OTHER Other Majors
Membership Authorization:

By completing this form I certify the following: I have met all membership eligibility
requirements for Phi Theta Kappa, and have been extended an invitation for
membership in my local chapter. I believe in and support the purpose of the
Society as stated in the Phi Theta Kappa Constitution (ptk.org), adhere to the
moral standards of the Society, and currently enjoy the full rights of citizenship,
freedom and privileges my country (International students attending college on a
United States student visa and who posses full rights of citizenship of their country
are eligible for membership.) An individual convicted of a felony, or any crime
whose potential sentence is greater than one year, may be considered for
membership three years following completion of all conditions of sentencing,
including probation. I understand that there is a required GPA of 3.2 to maintain
membership in Phi Theta Kappa and agree to notify my chapter advisor
immediately if at any time I fail to maintain my chapter’s maintenance GPA. I also
understand that there are required hours of service to maintain Active Membership
in the chapter. Therefore, I solemnly promise to uphold the standards of Phi Theta
Kappa, and to make this object and aim foremost in my mind, and I do solemnly
pledge allegiance to my fellow members and promise to aid them in all worthy
endeavors.

TWO REQUIRED REFERENCES:

(Must be a professor or current/former employer)
Name Email or Phone Signature

Prospective Member Signature ______________________________________

Date______________
Please submit this form with your payment of $55.
Only checks or money orders. NO CASH will be accepted.

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