Application for Initial and Continuing Membership
Alpha Gamma Sigma
California’s Honor Society for Community College Students
CCC Student ID __________________
This application is for Spring of _____ (year) Fall of_____ (year)
Have you ever been a member of AGS before at CCC? ___yes ___no. When __________________________
Last Name (print clearly) ___________________________ First Name (print clearly)_______________________
Street Address ________________________________________ City ____________________ Zip ___________
Home phone (____) _________________ Work phone (____) _________________ Cell phone (____) _________________
e-mail address _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
(Please print clearly, one character at a time. Clearly distinguish between 1 and 0 (the numbers) and l and o (the letters).
Major ___________________ Expected date of graduation ________ Expect to transfer to ______________________
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My GPA last semester was _________ (excluding summer). Must be 3.0 or higher.
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My cumulative GPA (for all college course work) is _______. Must be 3.0 or higher.
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Prior to this semester I have completed a total of __________ college units. Must be 12 or higher within a maximum
of 3 semesters.
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If your qualifying units and GPA are from another college you must attach a copy of your transcript to this application.
If your cumulative GPA is less than 3.0 due to grades earned more than two years ago you may use the Adjustment to Cumulative
GPA Worksheet. Attach worksheet to this application.
Check one of the following:_______ My dues are paid for this semester; I paid $28 last semester.
_______ I am enclosing $15 for dues for this semester only.
_______ I am enclosing $28 for dues for this and next semester.*
*If you pay now for next semester you must still turn in an application next semester.
_______ I am an EOPS student. My dues will be paid by EOPS.
Checks should be made payable to Alpha Gamma Sigma.
I understand that the above information will be verified and if I do not meet the minimum GPA and unit
requirements my application will not be approved and my dues will be returned. I also understand that in order to
be considered an active member I must also complete 10 hours of volunteer service and submit the Verification of
Volunteer Hours form by the last day of the semester.
Signature of applicant: ______________________________________________________date ________
Turn in your application to Maritza Vande Voorde, Counseling Office, SSC – 108D or during an AGS meeting. You
may also mail your application and dues to: Wendy Williams, Contra Costa College, 2600 Mission Bell Drive, San
Pablo, CA 94806
Questions call Maritza Jackson Sandoval, Counseling, x43908, Mjacksonsandoval@contracosta.edu, or
Patty Herrera x-43945, pherrera@contracosta.edu
For official use only==========================================================================================
Verification: Current GPA _______
If not approved, state reason
Cumulative GPA _______ Units _______
Approved ___ Not Approved ___ date ____
Dues paid: Amount __________ cash ___ check ____ (number ________); for Fall 20____ Spring 20____.
Signature of person accepting dues ________________________________________, date ________ Was receipt given? yes__no__