Only
typed applications will be honored.
College Name:
_____________________________________________________
This school is (check one):
___ Two year, public
___ Two
year, private
Department/Unit title:
_________________________________________________________
Department/Unit Phone Number:
(____)_____________
FAX number: (____)_____________
Faculty advisor:
_______________________________
Title:__________________________
Advisor's mailing address:
______________________________________________________
Advisor's phone number: (____
)__________________
FAX number: (____)______________
Advisor's e-mail address:
______________________________________________________
Chapter president:
______________________________
President’s phone number: (_____)____________
President’s
address:___________________________________________________________
The required procedures of your campus regarding
formation on an honor society must be fulfilled.
Please indicate if:
___
these requirements have been fulfilled and documentation is attached.
___
these requirements are in the process of being fulfilled.
___
there are no campus requirements/procedures for the formation of an honor
society.
I have attached documentation that the host
institution offers the minimum of 12 credits in communication and
communication-related courses which is a requirement for membership in
Sigma Chi Eta.
I, as an official representative of the
department/unit at this institution, attest that I have read the
requirements for Sigma Chi Eta chapter membership, as well as the
requirements for the selection of students for initiation. I agree that if
granted a charter, the chapter will abide by all of the requirements
stated. I further agree that the institution will fulfill all of the
chapter's financial obligations to the National Communication Association,
including the payment of a charter fee upon receipt of chapter
recognition, as well as the forwarding of individual member dues at the
time of each person's initiation.
Signature________________________________Date________________
Printed Name__________________________________________________
Mail to: Sigma Pi Eta, National Communication
Association, 1765 N Street, NW, Washington, D.C., 20036.
