UCF PSICHI THE NATIONAL HONOR SOCIETY IN PSYCHOLOGY
MA 2.0 [3ro8]
Name: First
Middle name/initial
Last
Email
Student ID number (PID)
Current mailing address: Street or PO Box
City I State I Zip
Permanent mailing address (if different from above)
City I State I Zip
Current Phone Number
Undergraduate Major
Minor
Permanent Phone Number
Graduate Major
Minor
Expected date of graduation (Month Day Year)
Class Standing
The following information is used only for internal Psi Chi statistical purposes.
OSophomore
OJunior
0Senior
Psi Beta Member:
Race Ethnicity: 0 Asian Pacific Islander
0 Black/African American
0 White/Caucasian
0 Mixed Racial Background 0 Other [specify]
0 No OYes
Gender: 0 Female 0 Male
0 Hispanic/Latino 0 Native American/Alaskan Native
I accept Psi Chi's Constitution. I hereby give my permission for the sponsor and/or officers of Psi Chi to review my
academic record in relation to my application for Psi Chi membership. I understand that my membership is dependent
upon meeting Psi Chi's membership requirements.
Date
Please affix a current psychology degree audit.
You must bring your application and degree audit to an officer during office hours to room PSY 323.
Once we review your application, you must pay a one-time payment of 60 dollars.
Please contact us if you have any questions by visiting us during our office hours or emailing us at
ucfpsichi@gmail.com
FOR OFFICE USE ONLY
Date Received in full:
--'-'--
Audit Attached:
Yes/ No
Dues Paid:
Yes/ No
Applicant Notified of Acceptance: YesJNo
Overall UCFHours Requirements Met:
Yes I No
UCF Psycholo!JY Hours Requirements Met: Yes I No
OveraiLUCF GPA Requirements Met:
Yes /No
UCF PsychologyGPARequlrements Met
Accepted:
Yes /No
Yes I No
Hours:
Hours:-GPA:
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GPA:---