Phi Beta Delta
Honor Society for International Scholars
Beta Chapter, California State University, Fullerton
www.fullerton.edu/international/pbd/
Application for Membership
Fall Deadline: October 16; Spring Deadline: April 8
MEMBERSHIP CRITERIA
EMBERSHIP CRITERIA
For Students
Membership is open to all who qualify following the completion of at least one semester of Cal State Fullerton
enrollment as an upper division or graduate student. Students must have a Grade Point Average of 3.2 or
higher (undergraduate), 3.5 or higher (graduate). In addition, students must demonstrate international
experience through a) completion of 6 units or more of international or intercultural coursework or b)
experience in living/studying/working abroad or research or involvement in other international endeavors.
Annual Dues: 1st year membership $70; renewal $25
For Faculty / Staff
Faculty may qualify by teaching courses in international or intercultural studies. Personal involvement in
international or intercultural affairs will be considered also. Staff may qualify by a combination of any of these.
Annual Dues: 1st year membership $80; renewal $50
To apply, please follow these instructions:
1) Type in your answers to this application, filling it out completely.
2) Print out the completed application.
3) Sign the printed application.
4) Make your application check payable to “Phi Beta Delta, CSUF” for $70 (students) or $80
(faculty/staff).
5) You need to submit your completed application BOTH electronically and as a hardcopy. For the
hardcopy, put your printed and signed application in an envelope along with your check, seal
the envelope, address it to Neil Kuritzky - PBD Treasurer, and deliver it to: Department of
Accounting, SGMH 4313. For the electronic copy, e-mail your application to
nkuritzky@fullerton.edu on or before the day that you submit your hardcopy printed
application and check.
6) The printed application, e-mailed application, and check all need to be submitted in order for
your application to be considered complete.
If you do not qualify for membership into Phi Beta Delta, your application fee will be fully refunded. Your
application fee includes the following benefits: one full year of membership dues, a bronze medallion on a
ribbon to be worn at Commencement, an official Certificate of Membership, and eligibility for PBD scholarships.
Name: (first)
(middle)
(last)
Mailing address:
CA
Street
Gender:
F
M
Apt #
Country of Birth:
Citizenship:
Languages spoken other than English:
Cell phone:
E-mail (must be CSUF e-mail address):
City
Home phone:
State
Zip
Please fill out either Part A or Part B.
A. STUDENTS
Major:
B. STAFF or FACULTY
Department/Office:
Minor (if applicable):
Position:
Class Standing:
Junior
Senior
Grad
Yes, F-1
Yes, J-1
Student ID #:
International student:
No
In what sem/yr do you plan to graduate?
1. COURSEWORK: List courses, taken or taught, with an international or intercultural context. Please indicate
semester, year, institution, title or content, department and course number, and grade.
Course
No. of Units
Grade
When
Where taken
2. EXPERIENCE ABROAD: Describe any experience(s) you have living/studying/working abroad. List places
and dates. Please elaborate in several sentences.
3. RESEARCH: List any research you have done (papers, presentations, publications, etc.) on international or
intercultural topics. Please include the dates.
Rev. 09/29/15 PBD
4. OTHER: List any other involvement in international endeavors that may qualify you. (For example: cultural
clubs, volunteer work with a global organization, ESL tutoring, hosting international students, etc.) Please
elaborate in several sentences.
5. Signature (for printed application):
FOR OFFICE USE ONLY
CSUF GPA:
Cumulative GPA:
Upper Division
Graduate or Post Baccalaureate
Printed name of person doing verification:
Rev. 09/29/15 PBD
Date: