Psi Chi application

Current JCU Psychology students who meet the criteria listed on the previous page may submit their application to Psi Chi by filling out this form and bringing a check for the one-time membership fee of $55.00 (payable to JCu Psychology Dept) to the Psychology office (Dolan E 301).

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Name

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Home Address

Street Address

please list your permanent address

City

State / Province / Region

ZIP / Postal Code

Country

Mobile Phone

Home Phone

Alternate Email

Banner Student ID#

Date of birth

Psi Chi application

JCU Psi Chi chapter membership application

Home Address