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Membership Application
Application for:
Birth Date:
Graduation Date:
First & Last Name:
Address:
City, State, Zip:
Phone:
E-mail:
Check each that applies to your goals after
your degree:
If other, please explain:
School Counselor
Rehabilitation Counselor
Substance Abuse Counselor
Couple/Family Counselor
LPC
Other
License #:
LPC-Intern
Certified?
Yes
No
Work or Practicum experience in counseling?
GPA:
In order to accept this invitation, please complete this local application and pay $30.00 local dues using a
PayPal link on the department’s website (Helpful Links for Students) or bring a check to the Counseling
Department Office in Durango Building Room 4.122. After verification, you will receive a notification email
from our Membership Chair, with instructions for completing the national application. In order to participate
in the fall initiation, both applications must be competed by March 16, 2015. Local approval is required
before you can apply nationally. Please keep that in mind when applying.
Your Chapter Faculty Advisor (CFA) is: Dr. Brenda Jones.
Once you complete the online local application, notify Dr. Jones ( brenda.jones@utsa.edu) and
Kristy Santibanez (kristylynn_4109@yahoo.com) that you have completed and turned in the local
application.
You must include a copy of your most recent transcript (unofficial available online at ASAP)
with the chapter application.
Your check will be deposited in the CSI Chapter bank account and all applicants' names will be forwarded to
CSI headquarters.
1. Notify Dr. Jones and Kristy Santibanez (kristylynn_4109@yahoo.com) that you have completed and turned
in the local application.
2. Local chapter dues are $30.00 and are to be turned in with this local chapter application. You can pay with
cash, check or money order. In order to ensure time to apply nationally ALL LOCAL APPLICATIONS ARE
DUE BY MARCH 16TH. ALL NATIONALAPPLICATIONS ARE DUE BY MARCH 20TH.
3. You must include a copy of your most recent transcript (unofficial available online at ASAP) with the
chapter application.
4. Your check will be deposited in the CSI Chapter bank account and all applicants' names will be forwarded
to CSI headquarters.
Any questions - e-mail kristylynn_4109@yahoo.com and yuliya.zholu@gmail.com
To submit payment online:
PAY CSI APPLICATION DUES
Checks can be made payable to Chi Sigma Iota
If sending checks by mail:
UTSA
Attn: Dr. Brenda Jones
Department of Counseling
501 W. Cesar E. Chavez Blvd.
San Antonio, Texas 78207-4415
Chi Sigma Iota, Sigma Alpha Chi Chapter
Code of Conduct
For as long as I am a member of Sigma Alpha Chi, I agree to:
1. Be ethical and fair minded in all matters.
2. Mentor new members & continually communicate with other members.
3. Actively participate in monthly chapter meetings.
4. Actively participate in at least 1 chapter activity each semester.
5. Actively participate and accept responsibility for 1 chapter activity each year.
6. Attend the annual Initiation Banquet for new members.
7. Mail in dues (renewals) to the chapter Treasurer by the specified time.
8. Update new contact or personal information with the chapter Secretary.
I will actively participate in the following committees:
(If selecting more than, one, please rank with "1" indicating your first choice and so on)
Awards
Memberships
Community
Projects
Newsletter
Fundraising
Donations
Professionals
Recruiting
If other, please explain:
I am interested in running for the following Chapter Executive Officer Position:
President
President-Elect
Secretary
Treasurer
Historian
Social Chair
Membership
Webmaster
Community Service
Fund-raising
Wellness Chair
Please take a moment to share any helpful hints, contacts, guest speakers or ideas below.
Social
Events
Chi Sigma Iota Application
Submit
Revised 1/2015