The National Leadership Honor Society Membership Form

Omicron Delta Kappa was the first college honor society of a national scope to give recognition and honor for meritorious leadership and service in extracurricular activities and to encourage development of general campus citizenship. Through membership in OΔK, you enter the ranks of over 300,000 women and men whose peers recognize them as scholars and leaders.

To be considered for membership, please fill out the following form and submit to your College/University Circle's Circle Coordinator. Please note that this form, fees, and participation in an induction ceremony are all prerequisites for membership in Omicron Delta Kappa.

This membership application form is only one component of the membership selection process. Please contact your local Circle Officers about deadlines and other possible additional Circle requirements. The national membership fee is $85.00. Individual circles may charge an additional amount or local dues.

Fields with a red asterisk * are required fields.

Student ID
Optional - for Circle Use Only

Initiation Data

* College/University Name:
* Initiation Class: Junior
Graduate Student
Honoris Causa

Personal Data

* First Name
Middle Name (complete or initial)
* Last Name
Jr., III, etc.
Your name as it should appear on the membership certificate:
* Permanent Home Address:
* City
* State
* Zip Code
* Permanent Home Phone:
* Cell Phone:
* School E-mail address:
* Personal E-mail address:
* Birth Date (MM/DD/YYYY):
Gender: Male     Female

Academic/Professional Data

** For Student Members (Junior, Senior, and Graduate) **

Cum GPA: *GPA Required
Grading scale:(3.0 or 4.0)
Anticipated Graduation Date (MM/YYYY)

** For Non-Student Members (Faculty Staff, Alumni, and Honoris Causa) **


Please list other colleges attended:

Name of College/University: Dates Attended: Degree Earned:

Significant Honors

** Students (Juniors, Seniors and Graduates)** Please list your honors/activities under the appropriate heading below:

I. Scholarship:
II. Athletics:
III. Campus or Community Service, Social, Religious Activities and Campus Government:
IV. Journalism, Publications, Speech, and the Mass Media:
V. Creative and Performing Arts:

** Non-Students (Faculty/Staff, Alumni, Honoris Causa) ** Please list your honors/activities under the heading below:

I. List Significant Honors and/or Achievements:

Pin Selection

* What type of pin would you prefer?
Laurel Crowned

Buckley Amendment Notice
By submitting this form, you authorize the members of the Circle of Omicron Delta Kappa Society. Inc. to which you are applying to review and discuss your grades and records of extracurricular activities that are maintained by your college/university or are submitted by you for their consideration. This authorization is granted because you would like to be considered for membership in Omicron Delta Kappa.

Optional - for additional Circle information if requested