Mu Alpha Theta Math Honor Society

Application for Membership

Name __________________________

Station _________________________

Class __________________________

Present Date ____________________

(1) Math Courses Completed            Final Grade             Teacher

Year 1

Year 2

Year 3

Year 4

(2) List years for which you received credit as an active member of Math Team.

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(3) If you have volunteered as a math assistant or math tutor and have received credit for this activity, please clip that statement, signed by the appropriate teacher, to this form.

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Student Signature