MORTAR BOARD, INC. PETITION FOR MORTAR BOARD POST-GRADUATE INITIATION (See Bylaws, Article III, Section 2.2) I. PROCEDURE: Alumni members of local honor societies installed as Mortar Board Chapters may become members after proper verification is received by sending a check for the sixty dollar ($60) membership fee (which includes the pin, certificate and Membership Booklet) to the National Office. These alumni are considered initiated through the National Office. - OR Alumni may request initiation at a ceremony by their own local chapter or at some other chapter of Mortar Board. If an alumnus is initiated by a collegiate chapter, the initiating chapter will do the following: 1. Give the alumnus a Mortar Board Membership Booklet, pin, and certificate. 2. Collect the $60 membership fee. 3. Include the initiate on its Official Membership Report. 4. Submit fee to the National Office with its Official Membership Report, collegiate fees, and this form immediately following the Initiation Ceremony. II. REQUEST FOR MEMBERSHIP STATUS: (Completion by the alumnus is required before either of the above procedures is followed). Name of alumnus requesting initiation: ____________________________________________________ Current Address: ____________________________________________________________________ City, State, Zip: _____________________________________________________________________ Phone: ________________________________ email: _____________________________________ Initiated into which local honor society? __________________________________________________ At which university? ____________________________________ Date of graduation: ______________ Year of initiation into local honor society: _________________ III. The Mortar Board National Office has master lists of names of members in all local honor societies after 1970, and verification of membership will be checked for those members of local groups without further reference. For any alumnus initiated into a local honor society which was installed as a chapter of Mortar Board before 1970, the following verification signature must be obtained. This is to certify that ________________________________________ was a member of The ____________________________________ chapter at ___________________________________ in the year __________________ when it was a local honor group, and graduated in ________________. Signature of current president of alumnus’ collegiate chapter or student personnel dean or senior advisor: ______________________________________________ Date: ________________________________ *The National Office will forward this information to the local chapter president for the above certification when it is necessary. The school where the alumnus was a local member will be notified by the National Office after the initiation so that his/her name can be added to the chapter roll. Please return to: Mortar Board National Office 1200 Chambers Rd. #201 Columbus, OH 43212-1753