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FACULTY OR ADMINISTRATOR

MEMBERSHIP APPLICATION FORM

NOHS * TUA National Honor Society * 90 Madison Street, Suite 206, Denver, CO 80206 * Ph: 303.320.5430 * Fax: 303.322.1455

Date:

A. Applicant Information

Please provide your name as you would like it to appear on the Membership

certificate. For example, Mary J. Smith or Mary Jane Smith etc.

Full Name:

Mailing Address:

City: State: Zip:

Telephone: () Cell: ()

Email:

B. University/College Information

Name of College/University:

Chapter (Greek name given by National Headquarters):

Chapter Advisor’s Name:

Address:

City: State: Zip:

Phone: () Fax: ()

Email:

C. Status

Faculty Administrator

Name of program of study and highest degree earned:

Grade Point Average: Graduation Date:

Teaching: Full-Time Part-Time Non-Applicable

How long at current college/university:

Classes taught in the last five years (catalogue designation and course title e.g., HMS101 Introduction to Human Services):

D. Leadership and Service

Please write short answers to the following questions in order to demonstrate your commitment and interest regarding your ability to work effectively with students, your desire to promote the ideals of the Society, and providing excellence in service to humanity.

1.  Write a brief statement that demonstrates your ability and commitment to work effectively with students:

2.  Identify community service projects/fundraising and/or volunteer work you have done:

3.  List current memberships (organizations, and other affiliations):

4.  Write a brief statement that demonstrates your commitment to the field of human services and your values/beliefs about providing excellence in service to humanity:

E. Commitment

In signing this application form for membership in Tau Upsilon Alpha National Organization for Human Services, I declare that the information I have provided on this form is true and correct and do hereby solemnly promise to pursue academic excellence, to maintain high moral and ethical character and to provide excellence in service to humanity. Furthermore, I commit myself to comply with and adhere to the By-Laws of the Tau Upsilon Alpha Honor Society, and to abide by the NOHS Code of Ethics.

Applicants Signature: ______Date:______

Print Name:______

Chapter Advisor’s Signature:______Date Received:______

For Chapter Advisor’s Office Use Only

NOHS * TUA National Honor Society * c/o Lauri Weiner, 1525 Greenspring Valley Rd. Stevenson, MD 21153-0641 * http://www.nationalhumanservices.org/tua-home

Date Received / Payment
Type, Number
and Amount / Level and Type of Membership / Official Transcript Received / Leadership & Service
______/ o Cash
o Check
o Money Order
Check/Money Order No.______
Amount Pd. $______/ o Bachelor
o Graduate
______
o Faculty
o Administrator / o Yes
o No
GPA ______/ o Ability and commitment to work with students
o Community service and/or fundraising
o Memberships (organizations and affiliations)
o Commitment to the field of Human Services
Time at college:
o One year or more full-time instructor/administrator
o Two years or more part-time instructor/administrator
Advisor’s Approval
o Yes
o No
Date Approved:
______

NOHS * TUA National Honor Society * c/o Lauri Weiner, 1525 Greenspring Valley Rd. Stevenson, MD 21153-0641 * http://www.nationalhumanservices.org/tua-home