Honor Society - Induction List Submission Form

Upsilon Sigma

Induction List Submission Form
READ THIS INFORMATION BEFORE COMPLETING FORM:

1. Only the Chapter Faculty Advisor may use this form AFTER receiving the official Charter Certificate from the UAA Executive Office.

2. Have your Charter Certificate on-hand to complete certiticate-specific form items below.

3. You will be asked to provide the names of all new eligible candidates to be inducted into your local chapter of Upsilon Sigma. Student information includes first name, last name, email address, and degree level (Bachelor, Master, or Doctoral)

4. You will be asked to provide the name and contact information of the invoice recipient. This is the person who will be responsible for processing the online credit card payment for the required inductees' fees. Reminder: The inductee fee for each student is $35, but a credit card processing fee will be added to your total payment.

Upsilon Sigma Chapter Information (as listed on your Charter Certificate)
Chapter Name (exactly as listed on your Charter Certificate)*
Chapter Number (exactly as listed on your Charter Certificate)*

New Student Induction List

Use our spreadsheet template (see below for URL) to upload your induction list.

Honor Society Induction List Spreadsheet Template:
(copy and paste URL into web browser address field)

https://docs.google.com/spreadsheets/d/13XGz3PwY1vwMK0l9gzlsQ4S2o9IBkKtXWQxGEl4q4wI/edit#gid=1211892093
Upload new student inductees' information: 1) First Name; 2) Last Name; 3) Email Address; and 4) Degree Level (Bachelor, Masters, or Doctoral)*

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Total Number of New Inductees*
Reminder: The inductee fee for each student is $35 plus credit card fees for processing.
Date of Planned Induction*

MonthDayYear
Date

Shipping Information for Student Certificates
Name of Person Who Should Receive Student Certificate Package*

First NameLast Name
Shipping Street Address (Line 1)*
Shipping Address (Line 2)
Shipping City*
Shipping State/Province/Region*
Shipping Zip or Regional Code*
Shipping Country*
Faculty Advisor

You will receive a copy of this form for your record after submission.
Name of Faculty Advisor*

First NameLast Name
Email of Faculty Advisor*
example@example.com
Phone Number of Faculty Advisor*
Please enter a valid phone number.

PAYMENT INFORMATION
Review information for accuracy.

Important: You will not be able to return to this page after you click the "SUBMIT" button below.

Click "SUBMIT" to complete.

Upsilon Sigma: One-Time Student Induction Fee Product Image

Upsilon Sigma: One-Time Student Induction FeeChange the quantity below to match the number of student induction fees you want to pay. Example: For 12 students, the quantity should be 12.

$35.00 Quantity

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty: