CHI SIGMA IOTA (CSI) INTERNATIONAL
BETA UPSILON CHAPTER
Student Application to Membership
*Apply by deadlines as set forth in the CSI calendar*
*Participation
in CSI Meetings, Events, & Activities prior to Membership is encouraged*
*
All applicants will be considered by the CSI Membership Committee & Executive Council for selection according to the ByLaws,
at which time letters of acceptance will be distributed* *Membership in the Society is not guaranteed*
_____
Submit this entire completed application including this checklist, the written portion (page 5), and the following:
_____
Attach the most recent unofficial copy of your grade transcripts or have a
faculty advisor
sign below verifying a minimum GPA of 3.5.
____________________________________________
Faculty Advisor Signature
_____
Obtain an endorsement from a full-time Barry University Counseling
Faculty member (form is included on pages 6 and
7, Chapter Advisor cannot be used as an endorser).
_____
Must have a minimum of 9 completed semester credit hours to be eligible
(you can begin
attending meetings before obtaining the 9 hours needed).
_____
Must attend 1/3 of chapter meetings and/or activities throughout one semester and complete 10 hours of service either
through CSI or through community service (document on page 8).
_____
Must adhere to all international requirements and Bylaws of Chi Sigma Iota (see www.csi-net.org)
_____
Agree to uphold the Chapter Bylaws, on-going membership standards (maintain attendance at 1/3 meetings and/or activities
and 10 hours of service to the Chapter, annually), and the standards as set forth in the Barry University Student Handbook
upon initiation.
*Please do not submit any forms of payment with the application.
Name: ____________________________________________
(please print)
Signature: _________________________________________
CHI SIGMA IOTA (CSI) INTERNATIONAL
BETA UPSILON CHAPTER
Alumni Application to Membership
*Apply
by deadlines as set forth in the CSI calendar*
*Participation in CSI Meetings,
Events, & Activities prior to Membership is encouraged*
* All applicants will
be considered by the CSI Membership Committee & Executive Council for selection according to the ByLaws, at which time
letters of acceptance will be distributed* *Membership in the Society is not guaranteed*
_____
Submit this entire completed application including this checklist, the written portion (page 5), and the following:
_____
Alumni applicants must have maintained an overall scholastic average of 3.5 or better (4.0 system) or the equivalent
while enrolled in the program. Attach the most recent unofficial copy of your graduate transcripts.
_____
Alumni applicants must be National Certified Counselors (NCC’s) with the National Board of Certified Counselors
(NBCC) or have an equivalent state counselor credentialing body, or be graduates of ACA/CACREP or CORE accredited programs.
Please attach a photocopy of relevant documentation to this application.
_____
Obtain an endorsement from a full-time Barry University Counseling
Faculty member (form is included on pages 6 and
7, Chapter Advisor cannot be used as an endorser).
_____
Attend two meetings or activities, or provide 5 hours of service to the Chapter prior to initiation (document on page
8).
_____ Must
adhere to all international requirements and Bylaws of Chi Sigma Iota (see www.csi-net.org)
_____
Agree to uphold the Chapter Bylaws and on-going membership standards (maintain attendance at 2 meetings or activities
and 8 hours of service to the Chapter, annually).
*Please do not submit any forms of payment with
the application
Name: ____________________________________________ (please print)
Signature: ______________________________________________
CHI SIGMA IOTA (CSI) INTERNATIONAL
BETA UPSILON CHAPTER
Faculty Application to Membership
*Apply by deadlines as set forth in the CSI calendar*
*Participation
in CSI Meetings, Events, & Activities prior to Membership is encouraged*
*
All applicants will be considered by the CSI Membership Committee & Executive Council for selection according to the ByLaws,
at which time letters of acceptance will be distributed* *Membership in the Society is not guaranteed*
_____
Submit this entire completed application including this checklist, the written portion (page 5), and the following
(disregard pages 6 & 7):
_____
Applicants must have maintained an overall scholastic average of 3.5 or better (4.0 system) or the equivalent while
enrolled in the program. Attach the most recent unofficial copy of your graduate transcripts.
_____
Faculty members must be National Certified Counselors (NCC’s) with the National Board of Certified Counselors
(NBCC) or have equivalent state counselor credentialing body, or be graduates of ACA/CACREP or CORE accredited programs or
the equivalent. Please attach a photocopy of relevant documentation to this application.
_____
Attend two meetings or activities, or provide 5 hours of service to the Chapter prior to initiation (document on page
8).
_____ Must
adhere to all international requirements and Bylaws of Chi Sigma Iota (see www.csi-net.org)
_____
Agree to uphold the Chapter Bylaws and on-going membership standards (maintain attendance at 2 meetings or activities
and 6 hours of service to the Chapter, annually).
*Please do not submit any forms of payment with
the application.
Name: ____________________________________________ (please print)
Signature: _________________________________________
CHI SIGMA IOTA
(CSI) INTERNATIONAL
BETA UPSILON CHAPTER
Professional Application
to Membership
*Apply by deadlines as set forth in the CSI
calendar*
*Participation in CSI Meetings, Events, & Activities prior to Membership
is encouraged*
* All applicants will be considered by the CSI Membership Committee &
Executive Council for selection according to the ByLaws, at which time letters of acceptance will be distributed* *Membership
in the Society is not guaranteed*
_____
Submit this entire completed application including this checklist, the written portion (page 5), and the following:
_____
Applicants must have maintained an overall scholastic average of 3.5 or better (4.0 system) or the equivalent while
enrolled in the program. Attach the most recent unofficial copy of your graduate transcripts.
_____
Professional members must be National Certified Counselors (NCC’s) with the National Board of Certified Counselors
(NBCC) or have equivalent state counselor credentialing body, or be graduates of ACA/CACREP or CORE accredited programs or
the equivalent. Please attach a photocopy of relevant documentation to this application.
_____
A Professional applicant needs an endorsement from a licensed mental health counselor or a full time faculty member
in a counselor education program (pages 6 & 7).
_____
Attend two meetings or activities, or provide 5 hours of service to the Chapter prior to initiation (document on page
8).
_____ Must
adhere to all international requirements and Bylaws of Chi Sigma Iota (see www.csi-net.org)
_____
Agree to uphold the Chapter Bylaws and on-going membership standards (maintain attendance at 2 meetings or activities
and 4 hours of service to the Chapter, annually).
*Please do not submit any forms of payment with
the application.
Name: ____________________________________________ (please print)
Signature: ______________________________________________
CHI SIGMA IOTA INTERNATIONAL
BETA UPSILON CHAPTER
WRITTEN REQUIREMENT
Please answer the following questions. The written requirement will give Beta Upsilon a clearer
picture of your expectations, qualifications, and willingness to provide service to the organization. Print
clearly or type.
1. Why do you want to join the Beta Upsilon chapter of Chi Sigma Iota?
Please be specific.
2. What can you offer as a future member to Chi Sigma Iota? Please
name two specific activities that you are interested in becoming involved in for Beta Upsilon.
3. What are your
leadership qualifications and abilities? Please be specific.
CHI SIGMA IOTA INTERNATIONAL
BETA UPSILON CHAPTER
ENDORSEMENT FORM
A student applicant needs
a full-time Barry University faculty member (other than the faculty advisor) to sign this endorsement form. A
professional, alumni or alumna applicant needs an endorsement from a licensed mental health counselor or full-time faculty
member in a counselor education program.
Endorsee (Name of Applicant) ________________________________________________________
TO THE RESPONDENT: The above named person is applying to become a member
of the Beta Upsilon Chapter of Chi Sigma Iota at Barry University. You have been chosen by the applicant
to aid us in the selection process by supplying an evaluation of his/her ability. We would appreciate it if you would comment
briefly on the applicant’s strengths and/or weaknesses as indicated below. (Please print or type)
___/___/____
___________________________________________________________
Date
Name of Person Endorsing New Member
_____________________________________________________________________________
Title
_______________________________________________________________________
Name of Agency or Institution
Address:______________________________________________________________________
Street
City
State Zip
Phone:
(______) ________ - ____________
--------------------------------------------------------------------------------------------------------------------
1.
I have known the applicant as: (Please circle) a graduate student; a professional; other _____________________
2. I
have known the applicant since ______________________________________________ in my position as: _____________________________________________________________________________.
Please rate
the applicant for each of the following characteristics by circling the appropriate point on the scale.
NO BASIS VERY LOW
AVERAGE HIGH VERY
HIGH |
A. Motivation
0
1 2 3
4 5 6 7
8 9 10
B. Intellectual
ability 0
1 2 3
4 5 6 7
8 9 10
C. Initiative
0
1 2 3
4 5 6 7
8 9 10
D. Cooperation
0
1 2 3
4 5 6 7
8 9 10
E. Leadership
ability 0
1 2 3
4 5 6 7
8 9 10
F. Grasp
of field 0
1 2 3
4 5 6 7
8 9 10
G. Demonstrates
0
1 2 3
4 5 6 7
8 9 10
excellence
H. Work Ethic
0
1 2 3
4 5 6
7 8 9 10
Feel free to write any comments
about the applicant on the back of this page.
Signature ___________________________________
Date _________________________
Return completed application to the respondent or to the following address:
Dr. Sylvia Fernandez
Professor/Faculty
Advisor
Barry University
Adrian Dominican School of Education
Powers Building
– Suite 278
11300 NE 2nd Avenue
Miami Shores, FL 33161-6695
smfernandez@mail.barry.edu
CHAPTER & COMMUNITY SERVICE HOURS
ATTESTATION FORM
Name
Hours
Supervisor
____________________________
_______
__________________
____________________________
_______
__________________
____________________________
_______
__________________
____________________________
_______
__________________
____________________________
_______
__________________
____________________________
_______
__________________
____________________________
_______
__________________
____________________________
_______
__________________
____________________________
_______
__________________
____________________________
_______
__________________
____________________________
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__________________
____________________________
_______
__________________
* The above person(s) volunteered their hours to the Chi Sigma Iota
Counseling Honor Society, Beta Upsilon Chapter.
***END OF APPLICATION***
