Phi Theta Kappa Enrollment Form

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You must complete and submit the Enrollment Form to be considered for scholarships and other exclusive membership benefits.

Additionally, you'll be automatically eligible for scholarships awarded during the year in varying numbers and in amounts up to $500 each.

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Name:  %%MEMBERNAME%%

Address:  

City:  

State:  

Zip/Postal Code:  

Country:  

Phone with Area Code:  

Keep your email address current so you will receive newsworthy information regarding Phi Theta Kappa programs, scholarships and exclusive membership benefits.

Email Address:  

Current information regarding your graduation date and major assists senior institutions in locating members eligible for over $35 million in Phi Theta Kappa transfer scholarships. If you do not know your exact graduation date, use a close approximation or the date you will complete your coursework at your current college.

Graduation/Transfer Date:  Month:   Year:

Current Major: 

Current Status

Members are requested to provide the following information to assist Phi Theta Kappa in three initiatives: access to statistical information based on the demographic information provided will result in increased scholarships for members; will allow the Society to seek grant funding to support scholastic service and leadership programs; and will strengthen Phi Theta Kappa's role in the higher education arena as an advocate for community college students. Information will only be released to senior institutions providing scholarship opportunities or other organizations providing benefits exclusively for Phi Theta Kappans.

Current Cumulative Grade Point Average:

Gender:  Male   Female

Date of Birth:

Ethnic Background:

Are you attending school in the United States on a student visa?

Do you attend college full-time? Yes   No

Degree Sought: 

Are you a Pell Grant recipient? Yes   No

Are you a student loan recipient? Yes   No

Future Plans

Do you expect to transfer to a senior institution? Yes   No

What is your expected date of transfer?  Month:   Year:

What is your expected major at a senior institution?

Will you attend full-time? Yes   No

Are you willing to transfer out of state? Yes   No

What is your long-range career field?

If you do not wish to receive email updates from Phi Theta Kappa, check here .

If you do not wish to receive information concerning special opportunities and scholarships for members, check here .

Phi Theta Kappa provides additional recognition to members by listing current members on our website.
    Please check here if you do not wish to have your name displayed as part of this listing .

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