Member Application Form Honor Society Member Application Student Name * Student's FBLA Member Number * Student's Email Address * Student's Grade * 9 10 11 12 FBLA Chapter Name * School Name * School Address * School Address School Address School Address City City State State Zip/Postal Zip/Postal Adviser Name * Adviser Email * Principal Name * Principal Email * Number of years of FBLA membership? * Have you competed at a NYS FBLA State Leadership Conference? * Yes No List the years you attended and the competitive events you participated in: Is your overall GPA 85% or above? * Yes No List any FBLA officer positions you have held or currently hold: List any committees you are a member of (identify any leadership positions): What are your career/future goals? * List any other clubs or organizations you are involved in: Please feel free to add any additional information you would like to share. How would you rate your community service involvement? * Minimal Average Exemplary Signature Name Name First First Last Last Date Submit If you are human, leave this field blank.
