Join Us Form

* = Required Information

Note: Information provided in this Application must match information on your HALL OF FAME VERIFICATION FORM

INDICATE THE ONE CATEGORY IN WHICH YOU ARE SEEKING MEMBERSHIP *

NAME OF STUDENT

First Name *

Middle Name

Last Name *

PERMANENT MAILING ADDRESS TO COMMUNICATE WITH YOU

Street number and name of street (include apartment number, if applicable) *

City/Home Town *

State *

Other

Zip Code/Postal Code (if none, enter "NA") *

Country *

E-mail Address *

Alternate E-mail Address

Telephone Number *

Telephone Area Code (if known)

Country Code (if known)

Year of Birth *

DEMOGRAPHIC DATA (For statistical use only) *

Other

Gender *

Your Country of Citizenship *

Name of Country where you earned degree/diploma/certificate *

STATS

Indicate the year you graduated *

Degree/Certificate you received (indicate only one) *

State your overall/cumulative, final GPA when you graduated. A GPA of 4 out of a maximum value of 4.0 should be written as 4.0/4.0 *

Indicate the maximum/highest GPA value used by your university, college, or high school *

Name of the Institution you graduated from *

The city the institution is located *

The state the institution is located *

Other

The country the institution is located *

Biographical Sketch (60 words limit) *

Full Biography (3 pages of text limit) *

Hall of Fame Essay (100 pages of text limit) *

Hall of Fame Speech Video *

GAMMA Honors Certificate *

PHOTO (upload your color photo – headshot only! (suit and tie preferred for men) -- size 180 x 180 pixes photo) *

Membership Fee

Consent and Approval

I, the undersigned and/or Applicant to the Academic Hall of Fame, hereby give consent and approval to the Academic Hall of Fame to use without restrictions all the information and material, including my photograph and written material submitted in support of my application for membership. This use includes editing any submissions for clarity or to meet editorial needs, the free use of the information in marketing and advertising the organization both online, and offline and the use of the material for fundraising or for sale. I further consent and approve the Hall of Fame ownership of copyright to my Hall of Fame Essay and Hall of Fame Speech with the understanding that I, the member, am not precluded from using same for my personal use.

I CONSENT AND APPROVE *

Applicant's Signature*(Print Your Name)

Today's Date *

Attestation

I hereby attest that the information submitted in this application is factual and truthful, with a clear understanding that any false information submitted or presented to AHOF will be grounds for delisting and cancellation of my membership in the Academic Hall of Fame.

**Please review your entry carefully before submitting**