2020 TUA Faculty Advisors Certification of New Membership Form

TUA UPSILON ALPHA NATIONAL HONOR SOCIETY“τελειότητα στην υπηρεσία στην ανθρωπότητατελειότητα στην υπηρεσία στην ανθρωπότητα Excellence in Service to Humanity TUA CHAPTER CERTIFICATION OF

TUA UPSILON ALPHA NATIONAL HONOR SOCIETY

“τελειότητα στην υπηρεσία στην ανθρωπότητατελειότητα στην υπηρεσία στην ανθρωπότητα

Excellence in Service to Humanity

TUA CHAPTER CERTIFICATION OF NEW MEMBERS FORM

This form must be signed by the TUA Chapter Faculty Advisor verifying all members’ eligibility and attesting to the fact that each named member has met the minimum standards for membership in Tau Upsilon Alpha

TUA Chapter Information

Date Submitted:      

Chapter (Greek name given by National Headquarters):     

Name of College/University:      

Advisor’s Name:      

Phone: (      )       Email:      

Induction Date:      

(If no induction date is given, we will use the date this form was submitted).

Certificates will be mailed to

Attention to:      

Name of College/University:      

Address:       City:       State:       Zip:      

Lifetime Membership Fees

Total number of Lifetime Membership Fees:       @ $40.00 = $      Total fees enclosed

All payments must be in the form of a college/university check, chapter check, cashier’s check or money order made payable to NOHS

the completed and signed application with the payment indicated above to:

Tau Upsilon Alpha Honor Society c/o NOHS

147 SE 102nd Avenue - Portland, OR 97216

I certify that all the individuals listed on this form have provided all information required, have paid their initiation fee and have attained the criteria required by Tau Upsilon Alpha, National Organization for Human Services Honor Society in order to be inducted

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Faculty Advisor’s Signature: Date:     

NEW CHAPTER MEMBER INDUCTEES

Full Name

as to appear on

membership certificate

Degree Level

select one

Type of Membership

select one

GPA

As on Official Transcript

Contact Information

If Student, Expected

City:      State:      ZIP:     

Email:     

Phone:(      )       Phone:(      )      

If Student, Expected

City:      State:      ZIP:     

Email:     

Phone:(      )       Phone:(      )      

If Student, Expected

City:      State:      ZIP:     

Email:     

Phone:(      )       Phone:(      )      

If Student, Expected

City:      State:      ZIP:     

Email:     

Phone:(      )       Phone:(      )      

If Student, Expected

City:      State:      ZIP:     

Email:     

Phone:(      )       Phone:(      )      

If Student, Expected

City:      State:      ZIP:     

Email:     

Phone:(      )       Phone:(      )      

If Student, Expected

City:      State:      ZIP:     

      Email:     

Phone:(      )       Phone:(      )      

If Student, Expected

City:      State:      ZIP:     

Email:     

Phone:(      )       Phone:(      )      

If Student, Expected

City:      State:      ZIP:     

Email:     

Phone:(      )       Phone:(      )      

If Student, Expected

City:      State:      ZIP:     

Email:     

Phone:(      )       Phone:(      )      

If Student, Expected

City:      State:      ZIP:     

Email:     

Phone:(      )       Phone:(      )      

If Student, Expected

City:      State:      ZIP:     

Email:     

Phone:(      )       Phone:(      )