Upsilon Pi Epsilon Membership Application
Computer Science Department
Michigan State University
Name(Please Print):_________________________________ PID:________________
Email Address:________________________ Level(Circle One): Undergrad
Grad
Local Address:_________________________________________________________
Permanent Address:____________________________________________________
Local Phone: (
)________________ Permanent Phone: (
)________________
If you were a member of UPE at another institution, please indicate the name of
that institution:_________________________________________________________
Please read the following statement and sign below if you agree to the terms stated:
I hereby grant permission to the faculty advisor of Upsilon Pi Epsilon to verify my
eligibility for membership in the honor society. I understand that the verification process
involves reviewing my academic record and that these records WILL NOT be made
public and will not be viewed by any person other than the faculty advisor.
Signature:________________________________________ Date:________________
Please return this form to 3115 EB by October 25 with $75 check payable to:
UPE Honor Society
Department of Computer Science &
Engineering
College of Engineering
Michigan State University
3115 Engineering Bldg.
Michigan State University
East Lansing, MI 48824