Phi Beta Delta Application

Phi Beta Delta International Honor Society

Eta Epsilon Chapter, Western Illinois University
APPLICATION FOR MEMBERSHIP

For more information and membership criteria, please visit the Phi Beta Delta Website or email pbd@wiu.edu.

Membership Dues:
- Faculty, staff, community members: $65 for the first year and $30 annually thereafter.
- Students: $35 for the first year and $30 annually thereafter.
Name*

First NameLast Name
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number (Home/Cell)*
Please enter a valid phone number.
Phone Number (Work)
Please enter a valid phone number.
Email Address*
example@wiu.edu
Gender*
Country of Birth
Citizenship
Languages spoken other than English
Applicant Status*

Current StudentNon-Student (Faculty, Staff, Community Member, etc.)

All Applicants
Please complete only the sections that apply to you. A minimum of one section must be completed. It is not neccesary to complete all sections for a successful application.
Your experience living/studying/teaching abroad. Please list places, dates, and description.
Your international research/publication. Please list titles/topics, date, description, and publication information.
Other involvement in international endeavors that may qualify you for membership (for example: clubs, organizations, volunteer community work, tutoring, hosting international students).
Please write a reflective summary demonstrating the impact the above information has had on your life (professional, intellectual, academic, and/or personal achievements). Maximum 500 words.*

0/500
Upload for Transcript, CV, or other supportive documentation

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THE DEADLINE TO SUBMIT MEMBERSHIP APPLICATIONS IS 4:30 PM, NOVEMBER 1 FOR FALL APPLICATIONS AND APRIL 1 FOR SPRING APPLICATIONS. INCOMPLETE APPLICATION PACKAGES WILL NOT BE CONSIDERED. PLEASE BE SURE YOUR APPLICATION PACKAGE INCLUDES EVERYTHING FROM THE CHECKLIST BELOW.
- Signed, completed application form (REQUIRED)
- Reflective summary (REQUIRED)
- Official WIU transcript (REQUIRED FOR STUDENT APPLICANTS ONLY)
  STUDENT APPLICANTS MUST HAVE A GPA FROM WIU TO BE CONSIDERED. SEE SPECIFICS ON THE PBD WEBSITE. PLEASE NOTE – FOR ELECTRONICALLY SUBMITTED APPLICATIONS, A SCANNED COPY OF AN OFFICIAL TRANSCRIPT IS ACCEPTABLE. FOR SUBMITTED PAPER APPLICATIONS, PLEASE BE SURE TO INCLUDE THE TRANSCRIPT WITH THE APPLICATION.
- Resume/curriculum vita (OPTIONAL)
- Additional supportive documentation (OPTIONAL)
Applicant Certification: By my signature I affirm that the information I have provided is true and correct. If I am accepted into the Eta Epsilon chapter of Phi Beta Delta, I agree to pay the first year’s membership dues by two weeks after the application deadline. *
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Phi Beta Delta International Honor Society

Student Applicant

Non-Student Applicant

All Applicants