PI SIGMA ALPHA

NATIONAL HONOR SOCIETY

FOR POLITICAL SCIENCE

Xi Omicron Chapter

APPLICATION FOR MEMBERSHIP

(Please Print)

Requirements for membership: 10 semester hours in political science completed, 3.25 G.P.A. overall, 3.4 G.P.A. in political science, and membership fees. (You do not need to be a political science major to be a member.)

1. Date of Application: ___________________

2. Name: ______________________________Student ID#: __________________

3. Major(s): _________________________Minor(s): _______________________

__________________________ ________________________

4. Date of Expected Graduation: _______________

5. Hours in Political Science Completed: _________

6. G.P.A. Overall: ____________ G.P.A. in Political Science: ____________

7. I have enclosed a Grade Printout ( )

8. Local Address: ____________________________________

____________________________________

9. Local Phone #: ___________________________

10. E-Mail Address: ____________________________

11. I have enclosed payment of $35.00 for dues ($30 one time national association

fee; $5 annual local chapter fee). Check ____ Cash ____ (check one). Make

checks payable to Pi Sigma Alpha.

________________________________

(Signed)

SUBMIT TO THE POLITICAL SCIENCE DEPARTMENT

STORCH MEMORIAL BUILDING RM. 105

BY MARCH 26, 2007