Application for Membership in Psi Beta

Last Name________________________ First Name___________________________

E-mail Address_________________________________________________________

Cell Phone_________________________    Home Phone _______________________

Mailing Address__________________________________________________________

_______________________________________________________________________

Year of Graduation from SCC ___________ Units Completed So Far __________

Cumulative GPA__________

Psychology GPA__________

Are you interested in? _____Active/involved membership      ____Officer positions     ____Inactive membership

Would you prefer a     ___GOLD or     ___SILVER     Membership Pin?

Attach a check for $55 payable to Dr. Cannon and a copy of your transcripts (unofficial okay) and return to Dr. Cannon in D 203-5 or:

Cari Cannon, Santiago Canyon College, 8045 Chapman Ave., Orange, CA 92869-4512