Membership Nomination Form

Membership Nomination Form
© Mortar Board, Inc.
The purpose of this nomination form is to acquaint Mortar Board with a nominee’s activities, interests and commitment to the Ideals of Mortar Board. A nominator may acquire the nominee’s information and résumé from the nominee directly or may nominate secretly based on the information known about the nominee.
The criteria for selection include a minimum GPA of 3.0 or top 35% of the junior class, whichever is higher, and a demonstrated commitment to scholarship, leadership and service. If the GPA is not known by the nominator, please nominate anyway. The Mortar Board chapter will verify GPAs. Some grade exceptions may be made by the chapter for candidates whose leadership and service are superior.
Self-nominations are acceptable.
Is this a self-nomination?
YesNo
NOMINATOR'S CONTACT INFORMATION
Self-nominees may skip this section.
Name*
Title*
Email address*
Phone number
NOMINEE'S CONTACT INFORMATION
Name*
Email*
Phone
Permanent address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
NOMINEE'S ACADEMIC INFORMATION
Major
Minor
GPA
Expected graduation date
Number of credit hours completed
How does the nominee demonstrate a true love of learning and commitment to academic excellence?
NOMINEE'S AWARDS AND INVOLVEMENT
Campus leadership
Awards or honors received
Community leadership
Contributions to academic department/unit/major
How does the nominee demonstrate earnest leadership beyond having a title?
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