DEPARTMENT OF HISTORY

MONTCLAIR STATE UNIVERSITY

PHI ALPHA THETA

APPLICATION

 

NAME

DATE:

 

 

 

 

PERMANENT ADDRESS:

 

 

 

 

 

CAMPUS ADDRESS:

PHONE:

 

 

MSU EMAIL ADDRESS:

 

 

 

CLASS YEAR:

MAJOR:

MINOR:

 

HISTORY COURSES TAKEN AT MONTCLAIR STATE UNIVERSITY (A minimum of 12 s.hrs. in History is required.)

 

     COURSE                                                                         INSTRUCTOR                GRADE

1.

 

 

2.

 

 

3.

 

 

4.

 

 

5.

 

 

6.

 

 

7.

 

 

8.

 

 

9.

 

 

10.

 

 

 

History Grade Point Average at MSU:

 

Overall Grade Point Average at MSU:

 

In which of the following activities of Phi alpha Theta would you be willing to participate?

 

_____ Program Planning

_____Newsletter

_____ Program Participant

_____ Hospitality

_____ Publicity

_____ Other

 

 

Note to Transfer Students:  We can accept history courses taken at other colleges or universities if you provide us with an official transcript.