Start an STTI Chapter - Pre-Application Form 2011-2013 by KBg23W

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                               Start An STTI Chapter: Pre-Application Form
Groups that are interested in forming a chapter of Sigma Theta Tau International (STTI) are asked to complete the
information requested on this form. Completion of this form helps STTI headquarters better serve the groups that are
interested in forming an honor society with the intent to apply to become a chapter of the organization.

Name and location of Institution of Higher Education

Name of University/Institute of Higher Education:

Name of School/Program of Nursing:

Name of Director/Dean of Nursing Program:

City:        State/Province:          Country:

Does this Institution of Higher Education have multiple locations or more than one campus offering nursing programs?
  Yes       No
        If yes:
              Does each location/campus have its own dean for its nursing programs?
              Please list each campus name and city and state:

Nursing Degree Programs

List all Programs              Program Type (check all that apply)          Program Location/           Approximate      List most recent
Currently Offered                                                           Campus                      Number of        accreditation
                     Traditional   Accelerated     Online     Other                                     Graduates        bodies and dates
(Include                                                                    (city, state/province,
                                                                                                        Per Year         for each program
Baccalaureate,                                                (Please       country)
                                                              describe)
Masters, Doctoral)




Method of Assessing Students

Does the university/institute use a 4.0 grade point average (GPA) grading system for its baccalaureate or equivalent
program?     Yes      No

If the university does not use a 4.0 GPA system, please describe in detail the grading system used including how the
highest 35 percent of their class in scholarship is determined.




                                                                          Start A STTI Chapter: Pre-Application Form; revised 20 October 2011
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Approval to Start a Nursing Honor Society with Intent to Apply for Chapter Status

Has the university/institute given approval to start the honor society and chapter development process?
  Yes      No

Has the school/department of nursing given approval to start the honor society and chapter development process?
  Yes      No


Name & Title of Primary Contact (with whom STTI headquarters should correspond)

Name:

Title:

Postal Mailing Address:

City:        State/Province:       Country:        Postal Code:

Telephone:          Fax:

Email Address:


Preferred Method of Communication

   Postal Mailing Address        Telephone     Email Address


Anticipated Date of Application*

Month:           Year:

*NOTE: Applicant groups must form and operate as an honor society according to the suggested guidelines and process
for at least 1-2 years. Groups are eligible to apply one year from the date of the first induction if they have completed at
least one membership renewal cycle. Application due dates are 15 February or 15 June of each year.

Submit completed form:

U.S./Canadian groups, send to:                            Non-U.S./Canadian groups, send to:

Chapter Services                                          Global Development
Sigma Theta Tau International                             Sigma Theta Tau International
550 West North Street                                     550 West North Street
Indianapolis, IN 46202                                    Indianapolis, IN 46202
USA                                                       USA
chapserv@stti.iupui.edu                                   global@stti.iupui.edu




                                                                   Start A STTI Chapter: Pre-Application Form; revised 20 October 2011
                                                                                                                              3




For STTI Governance Committee/Staff Use Only

Global Consultant assessment included? _______________


The STTI Governance Committee deems the following to be appropriate and equivalent:

_____ nursing program(s)

_____ program accreditation(s)

_____ method of assessing student achievement


Comments:




Date: ________________________________

Governance Committee Chair: ___________________________________________________________________

Staff: ________________________________________________________________________________________




                                                             Start A STTI Chapter: Pre-Application Form; revised 20 October 2011

								
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