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Phi Alpha Theta
Phi Alpha Theta
MEMBERSHIP APPLICATION
***
For Chapter Records Only
Name____________________________________________________________________________________________________________________________________________________________
(Please PRINT your name, as you want it to appear on the certificate: First-M- Last)
Graduate _____
Email: _____________________________________________________________________________________________________________________________
Permanent address: (Required for mailing The Historian):
___________________________________________________________________________________ZIP:______________________________________________
Local address:________________________________________________________________________________________________________________
___________________________________________________________________________________ZIP:_____________________________________________
Hours completed in History = ________ History GPA ________ Overall GPA = _________
(Basic requirements: at least 12 hrs History 3.1 or higher GPA in History and 3.0 or higher overall GPA)
Undergraduate record:
Schools attended
Dates
Major(s)
Degrees earned
Dates
Major(s)
Degrees earned