Mortar Board National Honor Society

Information Sheet for Membership Consideration

Name
Email Address (required)
Student Number
College
Expected Graduation Date
Total Hours
QPA
Major
Minor
If transfer, college(s) previously attended
If transfer, address of college(s) and dates attended
School Residence (include room number)
School Mailing Address
Local Phone
Permanent Mailing Address
Home Phone
Father's (Guardian) Name and Address
Mother's (Guardian) Name and Address

Please list below your most significant honors and accomplishments in order of priority to you.

Please use the return key when you reach the end of a line as if you were using a typewriter.

In a paragraph, please elaborate on the experience which has influenced you most since enrolling at the University of Alabama.

Again, please use the return key at the end of each line.

The Hypatia Chapter is unique in that it selects its incoming president from among those chosen for membership. If selected, would you like to be considered for president? (Your answer will not affect your application for general membership.)

Yes

No

Please read the following carefully!

"It is the individual's willingness to serve that differentiates Mortar Board from other honorary organizations. Acceptance of membership indicates the person's agreement to fulfill the responsibility of active participation in the chapter."

I have read the above statements and will abide by them if selected for membership. I also hereby grant permission to Mortar Board to check with the Records Office to verify my QPA.

You will receive an email confirming receipt of your application. If you have any questions or problems, please contact Shane Underwood.