Psi Chi Application

Please fill out this form to join Psi Chi. We look forward to having you as a member. We need your talents to help us make Psi Chi the most viable honor society on this campus. We hope you will join now.
Social Security #
Telephone #
Email Address
Major PsychGPA
Minor CumGPA
Major PsychGPA
Minor CumGPA
Estimated date of graduation (mo/yr)
By submitting this form,    I hereby give my permission for the faculty advisor of Psi Chi to review my academic record in relation to my application for Psi Chi membership. I understand that the Chapter fee is $20 and the National registration fee is $25, which pays for a lifetime membership, and that no dues are charged by the National Chapter. The total fee is $45.

Bring your check to the department office (KH C3104) or mail it to:

Psychology Department
Attn: James Gomez - Psi Chi Treasurer
5151 State University Drive
Los Angeles, California 90032

In an effort to make your membership with Psi Chi as rewarding as possible we plan events throughout the school year. As a prospective member of Psi Chi we would like to know what contributions you may be able to make that would be of benefit to this club. Please check any of those that apply:

Fund raisers (e.g. bake sales, candy sales, etc.)
Distribution of flyers
Informal social event (e.g. picnics, lunches, etc.)
Formal social/academic events
Phone calls
Other, please specify:
We also welcome any ideas of activities/events you would like to have for Psi Chi in the future. Please type any ideas below:
Psi Chi values the ideas and opinions of its members. This is why we encourage regular attendance at out club meeting. Not only does this give you an opportunity to let us know how Psi Chi can best meet your needs, but it also gives you a chance to get acquainted with other members and develop a sense of unity within our organization.

We do understand that with school, work and other commitments, certain times may make it difficult for you to attend our meetings. As a way of remedying this potential problem, we would like you to provide us wtih times that are most suitable for you. Doing so will help us to schedule our meeting in a way that will be most convenient to as much of our members as possible.

Mark all days that apply and indicate which times you will be available:

Monday a.m. p.m.
Tuesday a.m. p.m.
Wednesday a.m. p.m.
Thursday a.m. p.m.
Friday a.m. p.m.
Saturday a.m. p.m.

Good luck with your future endeavors and hope to hear from you again as a new member of Psi Chi!