MORTAR BOARD INFORMATION SHEET

Full Name:
Student ID: / Phone Number:
Primary Email Address:
Current Address:
Street / City, State / Zip Code
Permanent Address:
Street / City, State / Zip Code
Major (s): / Minor (s):
Total Units Completed: / Intended Graduation Date (MM/YY):
T-Shirt (Adult) Size: / Will you be studying abroad Spring 2014?
How did you hear about Mortar Board?

I certify that all of the above information listed is true to the best of my knowledge and realize that the Mortar Board advisor may verify information listed on this Information Sheet. I understand that membership shall be for one year, and I will be committed to active participation should I be selected. I hereby authorize the appointed Mortar Board selections officials to access my University records for the purpose of verifying my units, cumulative GPA, and Spring Quarter class schedule.

Signature: / Date:

Mortar Board membership requires excellence in the areas of Leadership, Scholarship, and Service. Activities and positions listed should be those done during college (i.e. do not list high school activities). Activities can be listed in more than one category.

Section 1: Leadership

Please list leadership positions in which you dedicated the most time (including campus organizations and/or community programs).

Organization / Leadership Position Held / Year(s) / Total Hours

Section 2: Scholarship

Please list your academic achievements received during college (awards, scholarships, honors).

Honors/Award / Date Received (MM/YY)

Section 3: Service

Please list involvement in volunteer service activities (including service to the campus community).

Service Activity / Number of hours per week / Number of weeks per year / Year(s) involved

ESSAY RESPONSES

1.  Choose one leadership activity from the above listed and elaborate on the scope of the position and reason for involvement. 10 sentences maximum
2.  Choose one academic achievement from the above listed and elaborate on the significance of the recognition. 5 sentences maximum
3.  Choose one service activity from the above listed and elaborate on the meaning of the involvement. 10 sentences maximum
4.  List any employment positions you have held during college. Indicate dates of involvement and hours per week.
5.  Personal Statement: Please provide a brief statement about yourself. Include what you feel you can specifically contribute to Mortar Board if selected. 300 words maximum
6.  Addendum (optional): Explain any inconsistencies or otherwise add anything that you feel adequately explains other parts of this application. 75 words maximum