Fillable Form 1: PHI THETA KAPPA MEMBERSHIP APPLICATION (Independence Community College)

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Form 1: PHI THETA KAPPA MEMBERSHIP APPLICATION (Independence Community College)

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PHI THETA KAPPA MEMBERSHIP APPLICATION
Completion of all sections of this application is a requirement of membership. Return this form to your local chapter advisor.
You may find your advisor’s contact information online at www.ptk.org/directories/chp_intro.htm.
Student ID# ______________________________________________________________________________________________________________
First Name _______________________________________________ Middle___________________________Last___________________________
Address __________________________________________________________________________________________________________________
City _____________________________________________ State/Province___________________________Zip/Postal Code____________________
Country _________________________ Telephone________________________E-Mail__________________________________________________
(Most correspondence is via email)
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4
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Academic Major Codes:
Undecided ........................................................................... UNDEC
Accounting ..............................................................................ACCT
Agricultural Sciences ................................................................AGRI
Architecture/Drafting ............................................................. ARCH
Art ..............................................................................................ART
Aviation ..................................................................................AVIAT
Biological Sciences ......................................................................BIO
Business ...................................................................................... BUS
Chemistry .............................................................................. CHEM
Communications .................................................................. COMM
Computer Sciences .................................................................COMP
Construction Trades .............................................................CONST
Counseling ..........................................................................COUNC
Criminal Justice .......................................................................CRIM
Dental Health ................................................................... DENTAL
Economics ..............................................................................ECON
Education/Teaching ............................................................... EDUC
Electronics ............................................................................... ELEC
Engineering Civil ............................................................ CIVLENG
Engineering Electrical .................................................... ELECENG
Engineering Mechanical .............................................. MECHENG
English ................................................................................... ENGL
Environmental Studies ....................................................... ENVIRO
Fashion/Merchandising ........................................................... FASH
Finance ........................................................................................FIN
General Science ........................................................................... SCI
Health Related Professions ...............................................HEALTH
History ..................................................................................... HIST
Information Technology .................................................. INFOTEC
Journalism/Broadcasting .....................................................JOURNL
Languages ............................................................................... LANG
Legal Services/Paralegal ....................................................... LEGAL
Liberal Arts/General Studies .............................................. LIBART
Marketing ......................................................................... MARKET
Management ........................................................................ MGMT
Mathematics .......................................................................... MATH
Medical Technology .........................................................MEDTEC
Music/Theatre/Dance ....................................................... THEATR
Nursing ....................................................................................NURS
Organizational Leadership ............................................... ORGLDR
Pharmacy .............................................................................PHARM
Physics ..................................................................................... PHYS
Political Science ................................................................... POLSCI
Precision Production Trades ................................................... PROD
Pre-Law .....................................................................................LAW
Pre-Medicine ............................................................................ MED
Psychology .............................................................................PSYCH
Public Administration and Services ................................. PUBADM
Public Relations/Advertising ..................................................... ADV
Religion/Bible ....................................................................... RELIG
Sociology/Social Science .......................................................SOCIO
Transportation and Material Moving .................................TRANSP
Travel/Tourism/Hotel Mgmt. ...............................................TRAVL
Veterinary Medicine ......................................................... VETMED
Other Major ........................................................................ OTHER
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Following the submission of your application to Phi Theta Kappa Headquarters you will receive:
• An email notification within twenty-four hours that your membership has been processed. This email will contain your membership identification
number allowing you full access to exclusive membership benefits.
If you do not wish to receive email updates from Phi Theta Kappa, check here
If you do not wish to receive information concerning special opportunities and scholarships for members, check here
I believe in and support the purpose of the Society, meet eligibility standards for membership as stated in the Phi Theta Kappa
Constitution and adhere to the moral standards of the Society. Therefore, I solemnly promise to uphold the standards of Phi Theta
Kappa, and to keep this object and aim in mind, and I do solemnly pledge allegiance to my fellow members and promise to aid them in
all worthy endeavors.
Signature Required _____________________________________________________________________ Date_______________________________
Phi Theta Kappa is committed to the elimination of discrimination based on gender, race, class, economic status, ethnic background, sexual orientation,
age, physical ability, and cultural and religious backgrounds.
www.ptk.org 1/2007
Graduation/Transfer from the Two-Year College: Month __________ Year__________
To complete your membership application, and to be considered for scholarships and other exclusive membership benefi ts, you must provide your
graduation or transfer date and major on this form. If you do not know the exact date, use a close approximation or the date you will complete
your coursework at this college.
Note: To become a member, an individual must meet all membership eligibility requirements for Phi Theta Kappa according to its Constitution and
Bylaw. Invitation to membership is extended by the local chapter. After becoming a member, an individual is required to maintain the minimum GPA
for membership as established by the local chapter and must notify the chapter advisor immediately if at any time their cumulative GPA falls below that
standard. Failure to provide notification may result in membership being automatically revoked. A member is given one term to raise their cumulative
GPA to minimum standards. A person currently incarcerated is ineligible 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 will attend the Induction
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Yes
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Form 1: PHI THETA KAPPA MEMBERSHIP APPLICATION (Independence Community College)

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Completed 25 July 2020

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