Membership Intent Form

The purposes of Sigma Theta Tau International are: 1. Recognize superior achievement.

2. Recognize the development of http://www.nursingsociety.org/membership/pages/default.aspx leadership qualities.

3. Foster high professional standards. Membership Intent Form Alpha Gamma Chapter 4. Encourage creative work.

5. Strengthen commitment to the ideals UNDERGRADUATE STUDENT and purposes of the profession. Please submit application by October 31, 2011 Circle your semester level and return forms to HB420 For further information contact faculty counselors: Dr Toby Adelman [email protected] or Lisa Rauch RN, MS, PHN [email protected]

Semester 6 Semester 7 Semester 8 Bridge Students

CRITERIA: Each undergraduate candidate for membership is required to meet the criteria for the undergraduate category of membership. Undergraduate students are required to have completed ½ of the nursing curriculum, have achieved a 3.0 GPA (SJSU Overall) on a 4.0 grading scale, rank in the upper 35% of the graduating class, and meet the expectation of academic integrity. Those who graduated last May or August are also eligible to apply as an undergraduate applicant.

Name (last) (first) (middle initial)

Present Address

City State Zip/Postal Code Country

Permanent Address

City State Zip/Postal Code Country

Phone E-mail Undergraduate Nursing Courses Completed: Please attach “mysjsu” list of courses and grades.*

(NOTE: attach an unofficial transcript to this); Just list all sem 3,4,5,6 courses and then what specifically you are taking in SEM 7 or 8)

Under the provisions of the “Family Educational Rights and Privacy Act of 1974,” I grant access to my academic record to the Chapter Governance Committee chairperson for consideration of my membership to Sigma Theta Tau International. I understand this invitation may be revoked between now and induction or thereafter if I am found guilty of a breach in academic integrity or other behaviors/actions inconsistent with the principles of the society.

Student’s Signature ______Date ______Please attach one membership endorsement form. (The endorser is required to hold active membership in Sigma Theta Tau International)* NOTE: An attached “mysjsu” list of courses and grades is required.

Sigma Theta Tau International 2011 Graduate Undergraduate Community Rev. 9/2011