Omicron Delta Kappa Honor Society at 
Juniata College
Honor Schedule Point System and Application

Please print, fill out and submit this form by Monday, Dec. 16, to Belle Tuten's office (I. Harvey Brumbaugh House, room 203) or to her mailbox (Campus box 597).

Please print or type.Data provided should be based on achievements, activities and participation during your enrollment at Juniata College only.Transfer students should attach an additional page explaining achievements and activities prior to attending Juniata.Academic standing will be considered in the selection process.

Name:_________________________________________SS#:___________________

            Last        First        MI

Current Mailing Address:________________________________________________________

                        Street or P.O. Box    City        State    Zip

Local Phone Number:_________________________E-mail Address:_______________

Permanent Mailing Address:______________________________________________________

                        Street or P.O. Box    City    State    Zip

Class:_______________POE:__________________________________________

Gender:____________________Birth date:___________________

Expected Graduation Date:_____________________Cumulative GPA:______________

How long have you attended Juniata College?_________________________

How did you hear about Omicron Delta Kappa selection or activities?_____________________

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Release Statement:I hereby authorize the members of the Omicron Delta Kappa Circle to review and discuss my grades and records of extracurricular activities concerning me that are maintained by Juniata or are submitted by me for their consideration.This authorization is granted because I would like to be considered for membership in Omicron Delta Kappa.

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Student’s Name (Print)        Student’s Signature        Date

Faculty Adviser Signature:____________________________________Date____________

Faculty Adviser Signature:____________________________________Date____________

List all organization memberships and offices held, honors received, and activities engaged in, both on and off campus while attending Juniata.Classify these in the following five leadership areas.Use an additional page if necessary.

1.Scholarship and Academics:

Honor Society Memberships, cumulative GPA, scholarships received, academic achievementsand awards.

2.Athletics:

Serving as captains and managers of varsity sports, assistant managers and team members, or participating in intramural sports.

3.Campus and Community Service:

Current President of any organization, current volunteer work, membership in student government, chairing or holding other offices in an organization, maintaining active membership in an organization for at least two years.

4.Creative and Performing Arts:(Arts exhibits, band, choir, theater productions, singing

productions, music writing and performances)

Major leads and roles or significant recognition for artistic creativity; other important roles or

offices and exhibits held.

5.Journalism:(Campus Media, publications)

Editors-in-chief and business managers of student publications, speech organizations, associate and managing editors and other important staff positions.