Petition For Degrees Template
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1Petition for Degrees
Fees
Dues:______________
Initiation:___________
Date:____________________
International Headquarters:__________
To the Worthy Matron, Officers and Members of_____________________________Chapter No.__________
(City, State, Province, Country)__________________________________________Order of the Eastern Star.
The undersigned respectfully petitions to receive the degrees of the Order of the Eastern Star, and become a member of
this Chapter. If accepted I pledge myself to a cheerful obedience of the laws of the Order. I have lived within the
Jurisdiction of this chapter (length of time) ________________________________________.
.
I have not petitioned any other Chapter and been rejected within the past two months
(
NOTE: If petitioner is a Majority Rainbow Girl or Job’s Daughter or was active for three years, a copy of the Majority certificate or proof of the three years
membership must accompany the petition. Masonic relationship is not required in these cases.
Masonic relationship:___________________________________of__________________________________
(Relationship)
(Name of Mason)
Member of ______________________________Lodge No._________ of ____________________________
(Name of Lodge)
(City, State)
(Application must be accompanied by above named Mason’s dues card or certificate of good standing in his lodge. If Mason is deceased, certificate of
good standing at time of his death should be attached.)
Do you believe in a Supreme Being?
Yes:
No:
Signed:_______________________________________ Print Name:________________________________
(Women must use their maiden surnames – as: (Mrs. Blanche Jones Smith). If married, not the names or initials of their husbands.
Residence:_______________________________________________________________________________
Telephone No.:_______________________________e-mail:______________________________________
Give names and addresses of three references who have known you for some time:
(These need not be members of The Order of The Eastern Star)
NAME
OCCUPATION
ADDRESS
_____________________________
_____________________ _______________________________
_____________________________
_____________________ _______________________________
_____________________________
_____________________ _______________________________
;
Recommended by
Referred to the following investigating committee:
(Signature required)
(one of which must be a Brother)
1.____________________________________________ 1._______________________________________
2.____________________________________________ 2._______________________________________
3._______________________________________
The undersigned, your committee appointed to investigate and report upon the foregoing petition, respectfully
state that they have discharged the trust confided to them, and report ______________ favorably.
Date:__________________________
____________________________________________
____________________________________________
____________________________________________
Name:_________________________________________ Birthday (MM/DD/YYYY:_________________
Presented:___________________Elected:________________Initiated:______________________________
Comments on back : Yes
No
Revised February 2011 Printed by: The Grand Chapter of North Carolina
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