AGLSP Institutional Membership Application

Institutional Membership Application

Use the form below to apply for an Institutional Membership.

NOTE: Applying does not guarantee acceptance into the association. Your application will be complete once approved and we have received membership dues.

Name of institution:

Program name:

Program email:

Program mailing address:

Address Line 1

Address Line 2

City

State

ZIP Code

Country

Program phone number:

Program fax number:

Website URL:

Contact Information

Director of Program:

Prefix (optional)

First Name

Initial (optional)

Last Name

Title:

Email:

Phone:

Academic Discipline / Specialty:

Program status:

Current Program Planning a Program

Institutional Membership Sponsor

Application for Institutional Membership requires sponsorship with a letter of support from an existing AGLSP Institutional member in good standing. Please provide your sponsor information below. You may upload a scanned copy of the letter you received from your Institutional Sponsor below.

Sponsor Program Institution:

Sponsor Institution Director Name:

Prefix (optional)

First Name

Initial (optional)

Last Name

Sponsor Institution Director Email:

I have requested a letter of Institutional Sponsorship from the program named above:

Yes - I have received a letter of support. Yes - I have requested a letter of support and am pending receipt. Not yet

Upload scanned copy of Institutional Sponsor Support Letter:

No File Chosen

File uploads may not work on some mobile devices.

PDF or Word documents only

Please enter the date of your request for Institutional Sponsorship:

You will be required to forward the letter of Institutional Sponsorship to the AGLSP Office once received before your application will be approved.

Statement of Application

I have read the Constitution of the Association of Graduate Liberal Studies Programs and understand the purpose and mission of the organization. The program I represent agrees to adhere to the principles and objectives of the Association. Your typed name serves as your signature in the box below.

Institutional representative name:

First Name

Initial (optional)

Last Name

Title:

The Annual Membership Fee is $400. You will be invoiced once your application is approved.

Please let us know how you would like to pay the Annual Membership Fee once your application is approved:

I will pay by credit card My institution will mail a check

You will receive an invoice from PayPal within 48 hours. There is no charge for this service and you do not have to have a PayPal account.

Institutional Membership Application

Contact Information

Current Program Information

Future Program Information

Institutional Membership Sponsor

Statement of Application