EmailMe Form - Tau Upsilon Alpha Chi Membership Application

Date Time *

MM / DD / YYYY

STUDENT ID # (A00.....) *

Applicant Information *

Student

Transferring Student

Alumni

Please provide your name as you would like it to appear on the Membership
certificate. For example, Mary J. Smith or Mary Jane Smith etc. *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone *

### - ### - ####

School Email *

Secondary Email *

Do you meet the GPA requirements of 3.25 or above? *

Yes

No

Have you completed at least 12 credit hours in Human Services or Social Services? *

Yes

No

Please check one: *

Name of program of study and degree being pursued or completed: *

Expected date of graduation or date graduated (Month/Year) *

Overall GPA *

Course catalog designations completed to date in the major (all courses required for your degree, not just human service courses e.g., ENG101 English Composition, HMS101 Introduction to Human Services):

Awareness of the Value of Service and Leadership

Please write short answers to the following questions in order to demonstrate your commitment to providing excellence in service to humanity.

State your professional goals: *

Identify community service projects/fundraising and/or volunteer work (includes community-based course work): *

List current memberships (organizations, campus clubs, and other affiliations): *

Write a brief statement that demonstrates your commitment to the field of human services and your values/beliefs about becoming a helping professional (whether in the nonprofit arena or case management): *

Acknowledgement *

I understand that my name may be acknowledged during the induction ceremony.

Applicant’s Commitment

In signing this application form for membership in Tau Upsilon Alpha National Organization for Human Services, I declare that the information I have provided on this form is true and correct and do hereby solemnly promise to pursue academic excellence, to maintain high moral and ethical character and to provide excellence in service to humanity. Furthermore, I commit myself to comply with and adhere to the By-Laws of the Tau Upsilon Alpha Honor Society, and to abide by the NOHS Code of Ethics.

After you submit this form, you will be re-directed to the Walden University Payment Portal to pay your $80 (non-refundable) membership fee.

Electronic Signature (use cursor) *

Clear

Date Time *

MM / DD / YYYY

Printed Name *

Unofficial or Official Transcript *