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Membership Application

Full Name

Date of Birth

Mailing Address (number, street, suite, apt.)

City

State

Email

Sponsoring HPAT Member

Postal Code

Home Phone Number

Cell Phone Number

Education Information

Highest Level of Education

College/University

Degree (if applicable)

High School

Professional Information

Occupation

Current employer

Employee since (year)

Business Address (number,street,suite, apt.)

City

State

Postal Code

All information will be Confidential, Securely Stored, and Disposed of Properly

1. Statement of interest: Why would you like to join HPAT?

2. Community issues: What do you believe are the three most important issues facing the Hispanic community in Tyler?

References

Every HPAT member is asked to provide a total of THREE character references that will be checked. Please notify your references that you have listed them. Please provide ONE professional reference, ONE community reference, and ONE personal reference of someone that you have known for at least 2 years (please no family members, spouses, or significant others).

1. Professional Reference

Full Name

Email

Cell Phone Number

2. Community References

Full Name

Email

Cell Phone Number

3. Personal References

Full Name

Email

Cell Phone Number

Verification

I hereby attest that all information is accurate and true and understand that supplying incomplete or inaccurate information may result in my denial and/or removal from HPAT. I also agree to inform the HPAT Secretary or Officers if any of the information on this document changes

Your Signature

Date

HPAT Conduct Standards

General Conduct: As representatives of the Hispanic Professionals Association of Tyler we must hold ourselves to the highest standard. Showing professionalism and respect for our community and acting at all times as if representing the entire organization is important to maintain respect for ourselves, our work, our programs, and HPAT as a whole.

I hereby agree to abide by all the above statements.

Your Signature

Date

Thanks for applying!
We’ll get back to you soon.

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