Alpha Epsilon Lambda
The honor society of graduate and professional school students
(Mr. /Ms.) Last Name First Name Middle Initial
J-Number: __________________________
Present Address: _______________________________________________________________
City State Zip Code
Telephone: E-mail
Cumulative G.P.A. Hours Earned:
Major: Anticipated Graduation:
Your name as you want it to appear on your certificate:
LEADERSHIP QUALIFICATIONS
Provide a brief list of your leadership experience as a graduate or professional school student.
This may include on-campus or off-campus activities.
Signature: Date:
Return completed application and membership dues ($50.00) by March 11, 2019 to:
Jackson State University–Graduate Studies
P.O. Box 17095 Jackson, MS 39217
