Chaffey College Honors Program

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Chaffey Phi Theta Kappa Chapter

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Phi Theta Kappa

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INTENT TO COMPLETE THE HONORS PROGRAM

By completing and submitting this form you declare your intention to meet all obligations required by the Honors Program and you verify that the e-mail address used will serve as your electronic signature to this commitment.

This form must be submitted no later than
March 25, 2010

Last Name:
*

First Name:
*

Middle Name / Initial:

Chaffey Student ID Number:

Mailing Address

Street:

City:

State:

Zip Code:

Phone (include area code):

E-mail Address:
*

CHECK IF APPLICABLE:

	I WILL CONTINUE TO ATTEND CHAFFEY. Projected completion date:
	I have not fulfilled all the requirements for the Honors Program graduation, but I do intend to transfer to a four-year school after the spring semester.
	I have or will have completed all Honors Program requirements by the end of the semester to graduate from the Honors Program.
	List the four-year institutions which you have applied to:
	I wish to participate in the upcoming Honors Graduation Dinner. MANDATORY: I have contacted this professor/counselor to speak on my behalf at the dinner: *

PLEASE CHECK ALL OBLIGATIONS MET FOR HONORS PROGRAM GRADUATION:

	Maintained a GPA of 3.0 or higher
	Completed 54 hours of community service Completed the two- to three-page paper TOPIC: How the Honors Program and My Community Service Influenced My Life While At Chaffey College Turned in proof of service hours
	Completed 18 semester units in Honors Classes. List the classes, including courses in progress (e.g., English 1A):

Additional comments or information relevant to this application:

* Required Fields

PROGRAM CONTACTS

909-652-6263

honors.program@chaffey.edu

Honors Program Staff

Carmen Navarro
Director

Peg Slagel
Administrative Assistant

Committee Members

Ardon Alger
Sid Burks
Kevin Cameron
Ryan Falcioni
Leona Fisher
Laura Hope
Bonnie Khaw-Posthuma
Meng Khou
Carmen Navarro
Cynthia Parker
Eva Rose
Susan Starr
Pak Tang
Theresa Thompson
Carrie Veazey