(Insignia)
NATIONAL ORGANIZATION FOR HUMAN SERVICES
HONOR SOCIETY
“τελειότητα στην υπηρεσία στην ανθρωπότητα”
Excellence in Service to Humanity
TAU UPSILON ALPHA
National Honor Society
HONORARY
MEMBERSHIP APPLICATION FORM
Date:
A. Applicant Information
Please provide your name as you would like it to appear on the Membership
certificate. For example, Mary J. Smith or Mary Jane Smith etc.
Full Name:
Mailing Address:
City:
Telephone: (
State:
)
Cell: (
Zip:
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Email:
B. University/College Information Honoring Applicant
Name of College/University:
Chapter (Greek name given by National Headquarters):
Chapter Advisor’s Name:
Address:
City:
State:
Zip:
Phone: (
)
Fax: (
)
Email:
C. Status
Practitioner
Faculty
Administrator
Name of program of study and highest degree earned:
Graduation Date:
Organization(s)/Affiliation(s):
Field of Expertise:
TUA National Honor Society * 1600 Sarno Rd Ste. 16, Melbourne, FL 32935 * Ph: 800.597.2306
Honorary Membership Application - Page 2 of 2
D. Leadership and Service Being Honored For
Please write short answers to the following questions in order to demonstrate reasons for honor. The information should
reflect commitment to promoting the ideals of the Society, and providing excellence in service to humanity.
1. Brief history of achievements by honorary:
2. Identify community service projects/fundraising and/or volunteer work:
3. List current memberships (organizations, and other affiliations):
4. List any publications by honorary:
5. Write a brief statement that demonstrates the outstanding commitment to the field of human
services:
6. Write a brief statement regarding the values/beliefs in providing excellence in service to
humanity:
Note: A resume and short biography is to accompany this application.
E. Commitment of Honorary
In signing this application form for membership in Tau Upsilon Alpha National Organization for Human
Services, I declare that the information that has been provided on this form is true and correct and do
hereby solemnly promise to pursue academic excellence, to maintain high moral and ethical character
and to provide excellence in service to humanity. Furthermore, I commit myself to comply with and
adhere to the By-Laws of the Tau Upsilon Alpha Honor Society, and to abide by the NOHS Code of
Ethics.
Honoree’s Signature: ________________________
Date:________________
Print Name:_________________________________
Chapter Advisor’s Signature:______________________ Date Received:______________
For Chapter Advisor’s Office Use Only
Date
Received
____________
Advisor’s
Approval
 Yes
Payment
Type, Number
and Amount
* to be paid by chapter
on behalf of the person
being honored
 Honorary
_____________
 Cash
Highest level of
Education:
 Check
 Bachelor
 Money Order
 Graduate
 No
Check/Money Order
No.________________
Date Approved:
Amount Pd. $________
____________
Level and
Type of
Membership
__________________________
 Practitioner
 Faculty
 Administrator
Comments
Demonstration of Outstanding
Leadership & Service
 Outstanding professional achievement
 Outstanding service to the Human Services field
Membership Elected
Elected by a two-thirds (2/3) vote of the chapter
membership
Total chapter membership _________
Total membership approved ________
Date of vote:__________
TUA National Honor Society * 1600 Sarno Rd Ste. 16, Melbourne, FL 32935 * Ph: 800.597.2306