Phi Theta Kappa - Honor Society

Correction Certificate or Membership Card Request Form

Members or chapter advisors may use this form to request a correction certificate for members already reported to International Headquarters. There is a $10.00 processing fee for replacements due to loss or name change. Delivery time for replacement certificates is 7-10 days.
To order a replacement, please remit $10.00 to: Phi Theta Kappa Honor Society
Certificate Processing
1625 Eastover Dr.
Jackson, MS 39211

Name as reported to Headquarters when inducted:

Membership identification number:

College Name:

Chapter Name:

Induction Date:

Email Address:

Phone Number:

Requesting: Certificate   Member Card

Name as it should appear on the new certificate or card:

New certificate or card should be mailed to:

Address:

City:

State:  

Zip Code:  

Is this a new address? Yes   No

Why are you requesting this replacement certificate or card?

Please not, letters of recommendation may be requested through the Get Connected Phi Theta Kappa Network free of charge as proof of membership.