Campus: Please Check
UPC____
NC____
BT____
Delta Iota Chapter
Florida International University
Membership Application
Name: __________________________________________________
Address:
_____________________________________________________
City, State, Zip Code:
_____________________________________________________
Telephone:
(Home)_______________________________________________
(Business)_____________________________________________
E-Mail address:
______________________________________________________
Social Security #:
______________________________________________________
Program: _________ BSSW *GPA _______ (Overall)
_______Social Work courses
Expected Date of Graduation: ____________________________________________________
It is the student’s responsibility to notify Prof. Hayden’s office if your date of graduation changes. Failure to do so may result in your name being omitted from the graduation Honor Society List.
Present Employment: ______________________________________________________
______________________________________________________
Position:
______________________________________________________
Please write a brief statement regarding your reason for wanting to join Phi Alpha.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Area of Interest: ___________________________________________________________
___________________________________________________________
*Print this form & submit along with your dues of $35 to Mary Helen Hayden, Florida International University, University Park, School of Social Work ECS 459B, Miami, FL. 33199.
