Mensa Certificate Template Form PDF Details

Are you looking for a Mensa certificate template form to recognize the impressive intelligence of someone in your life? An IQ score within the top 2% of test takers is something worth celebrating and commemorating! But, how do you go about doing that? If this is your current question, look no further – this blog post covers all the details so that you can feel confident in honoring brilliant minds with an official Mensa certificate. Learn what it takes to obtain an official certificate from Mensa International and find out exactly where to get a free or customizable template form.

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Form NameMensa Certificate Template Form
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Avg. time to fill out1 min 45 sec
Other namesfillable iq certificate, mensa certificate generator, mensa membership certificate, mensa iq test certificate

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Earn a commemorative certificate in

recognition of your outstanding

achievement and get an Excellence in

Reading T-shirt, too!

The Mensa Foundation recognizes and encourages education, gifted youth and lifelong learning through programs like the Mensa for Kids Web site and other activities.

To encourage the joy of reading, the Foundation has developed the Mensa for Kids Excellence in Reading Award Program!

Acknowledging the value of the National Endowment for the Humanities’ appreciation of classic literature for young people, the Mensa Foundation is providing a year- round challenge to kids of all ages based on the NEH’s “Summertime Reading” list.

To participate in the Mensa for Kids Excellence in Reading Award Program, follow these steps:

1.Find the grade-level segment that best fits your reading level from the list of books provided. You’ll receive recognition for each segment read! Remember to read to the level of your ability, regardless of your age or grade level.

2.Print the appropriate segment and track each book you read.

3.Once you’ve completed an entire segment list, you and a parent will need to sign the list as verification and return it and the order form to the Mensa Foundation at the address provided. Once we’ve received your signed list, we’ll send you an award certificate and T-shirt! Please allow 4-6 weeks for delivery.

Important questions answered

Can parents read aloud to their child? Does that count?

Yes! The books may be read aloud. Kids can also listen to audio books or read the books online.

Can teenagers receive rewards for the lower grade segments?

Yes! We recommend that kids begin at the reading level best for them and then move forward or backward in the list.

Are there additional prizes?

Everyone who completes a segment list will be awarded a certificate and a Mensa for Kids T-shirt for the first segment completed. Additional segments will be recognized with certificates. This is not a competition, though, and there are no monetary prizes.

What if it says “series”? Do participants have to read all of them?

Yes. That’s why this is a tremendous accomplishment, worthy of recognition.

One final note: Parents should exercise care when selecting an appropriate volume of the assigned reading; original versions of some older fables and tales may be inappropriate for small children.

©The Mensa for Kids “Excellence in Reading” Award program is the property of the Mensa Education & Research Foundation, www.mensafoundation.org. The program is provided as a complimentary service to the public. Reproduction and distribution without modification is allowed. Images, links and linked content referenced herein are the property of the originating entities.

Mensa for Kids Excellence in Reading Award Program

List 1: Kindergarten through Grade 3

Please check off each box as the book, series, or compilation is completed.

Alexander and the Terrible, No Good, Very Bad Day Viorst, Judith

All-of-a-Kind Family – Taylor, Sydney

Amelia Bedelia Parish, Peggy

Anansi the Spider McDermott, Gerald

Bedtime for Frances Hoban, Russell

Blueberries for Sal McCloskey, Robert

The Cabin Faced West Fritz, Jean

The Carrot Seed Krauss, Ruth

The Cat in the Hat Seuss, Dr.

Charlotte’s Web White, E.B.

Cloudy with a Chance of Meatballs – Barrett, Judy

Corduroy Freeman, Don

The Cricket in Times Square Selden, George

Curious George – Rey, H.A.

The Dot – Reynolds, Peter

Freckle Juice Blume, Judy

Frederick Lionni, Leo

Frog and Toad Are Friends Lobel, Arnold

The Garden of Abdul Gasazi Van Allsburg, Chris

George and Martha Marshall, James

Goodnight, Moon Brown, Margaret Wise

Harry the Dirty Dog Zion, Gene

How the Leopard Got His Claws – Achebe, Chinua

The Hundred Dresses – Estes, Eleanor

I Want My Hat Back – Klassen, Jon

If I Never Forever Endeavor – Meade, Holly

Leo the Late Bloomer Kraus, Robert

The Little Engine That Could Piper, Watty

Little House on the Prairie Wilder, Laura Ingalls

Little Toot Gramatky, Hardie

The Littles – Peterson, John

Madeline Bemelmans, Ludwig

Make Way for Ducklings McCloskey, Robert

Mike Mulligan and His Steam Shovel Burton, Virginia Lee

Millions of Cats Gag, Wanda

The Mouse and the Motorcycle Cleary, Beverly

Mr. Popper’s Penguins Atwater, Richard and Florence

Mrs. Frisby and the Rats of Nimh – O’Brien, Robert

Paul Revere’s Ride Longfellow, Henry Wadsworth

The Polar Express – Chris Van Allsburg

Peppe the Lamplighter – Bartone, Elisa

Pippi Longstocking - Lindgren, Astrid

Put Me in the Zoo Lopshire, Robert

Rabbit Hill Lawson, Robert

Ramona Quimby, Age 8 Cleary, Beverly

The Quiltmaker’s Gift Brumbeau, Jeff

The Reluctant Dragon Grahame, Kenneth

Sam the Minuteman Benchley, Nathaniel

Sarah, Plain and Tall – MacLachlan, Patricia

Shiloh – Naylor, Phyllis Reynolds

The Snowy Day Keats, Ezra Jack

The Stinky Cheese Man & Other Fairly Stupid Tales Scieszka, Jon

Stone Soup Brown, Marcia

Tale of Despereaux – DiCamillo, Kate

The Story of Babar Brunhoff, Jean de

The Story of Ferdinand Leaf, Munro

Strega Nona dePaola, Tomie

Stellaluna Cannon, Janell

Sylvester and the Magic Pebble

Steig, William

The Tale of Peter Rabbit Potter, Beatrix

The Three Little Pigs Galdone, Paul

Tikki Tikki Tembo – Mosel, Arlene

Where the Wild Things Are Sendak, Maurice

Winnie-the-Pooh Milne, A.A.

By signing below, we attest that _____________________________________ has read all of the books

marked as read on the list above.

________________________________

________________________________

Reader’s signature

Parent’s signature

Return with order form to the Mensa Foundation, 1229 Corporate Drive West, Arlington, Texas 76006-6103,

fax to 817-649–5232 or scan to ReaderAward@mensafoundation.org.

©The Mensa for Kids Excellence in Reading Award program is the property of the Mensa Education & Research Foundation, www.mensafoundation.org. The program is provided as a complimentary service to the public. Reproduction and distribution without modification is allowed. Images, links and linked content referenced herein are the property of the originating entities.

Mensa for Kids Excellence in Reading Award Program

List 2: Grades 4–6

Please check off each box as the book, series, or compilation is completed.

Alice in Wonderland - Carroll, Lewis

Anne of Green Gables – Montgomery, L.M.

Ben and Me – Lawson, Robert

Betsy-Tacy – Lovelace, Maud Hart

Black Beauty – Sewell, Anna

The Black Stallion – Farley, Walter

The Borrowers – Norton, Mary

Bridge to Terabithia – Paterson, Katherine

Caddie Woodlawn – Brink, Carol Ryrie

Cheaper by the Dozen – Gilbreth, Frank

The Children of Green Knowe – Boston, L.M.

Chronicles of Prydain – Alexander, Lloyd (entire series as listed below)

The Book of Three

The Black Cauldron

The Castle of Llyr

Taran Wanderer

The High King

The Complete Chronicles of Narnia – Lewis, C.S. (entire series as listed below)

The Magician’s Nephew

The Lion, the Witch and the Wardrobe

The Horse and his Boy

Prince Caspian: The Return to Narnia

The Voyage of the Dawn Treader

The Silver Chair

The Last Battle

The Complete Fairy Tales (all eleven tales)

Perrault, Charles

The Dark is Rising Sequence

Cooper, Susan (entire series as listed below)

Over Sea, Under Stone The Dark Is Rising

Greenwitch

The Grey King

Silver on the Tree.

D’Aulaire’s Book of Greek Myths – d’Aulaire, Ingri and Edgar

D’Aulaire’s Book of Norse Myths – d’Aulaire, Ingri and Edgar

A Dog on Barkham Street – Stolz, Mary

The Evolution of Calpurnia Tate – Kelly, Jacqueline

From the Mixed-up Files of Mrs. Basil E. Frankweiler – Konigsburg, E.L.

Gentle Ben – Morey, Walt

Hatchet – Paulsen, Gary

Hans Brinker, or The Silver Skates – Dodge, Mary Mapes

Harriet the Spy – Fitzhugh, Louise

Heidi – Spyri, Johanna

Homer Price – McCloskey, Robert

The House of Dies Drear – Hamilton, Virginia

The Jungle Book – Kipling, Rudyard

Lad: A Dog – Terhune, Albert Payson

Lassie Come Home – Knight, Eric

Mary Poppins – Travers, Pamela l.

Matilda – Dahl, Roald

The Matchlock Gun – Edmonds, Walter D.

Misty of Chincoteague – Henry, Marguerite

The Moffats – Estes, Eleanor

My Side of the Mountain – George, Jeanne Craighead

The Pushcart War – Merrill, Jean

The Railway Children – Nesbit, E.

Redwall – Jacques, Brian

The Rescuers – Sharp, Margery

Roller Skates – Sawyer, Ruth

The Secret Garden – Burnett, France Hodgson

Strawberry Girl – Lenski, Lois

The Summer of the Swans – Byers, Betsy

Swiss Family Robinson – Wyss, Johann

The Twenty-One Balloons – du Bois, William Pene

The Wonderful Wizard of Oz – Baum, L. Frank

Thimble Summer – Enright, Elizabeth

Tuck Everlasting – Babbitt, Natalie

By signing below, we attest that _____________________________________ has read all of the books

marked as read on the list above.

________________________________

________________________________

Reader’s signature

Parent’s signature

Return with order form to the Mensa Foundation, 1229 Corporate Drive West, Arlington, Texas 76006-6103,

fax to 817-649–5232 or scan to ReaderAward@mensafoundation.org.

©The Mensa for Kids Excellence in Reading Award program is the property of the Mensa Education & Research Foundation, www.mensafoundation.org. The program is provided as a complimentary service to the public. Reproduction and distribution without modification is allowed. Images, links and linked content referenced herein are the property of the originating entities.

Mensa for Kids Excellence in Reading Award Program

List 3: Grades 7–8

Please check off each box as the book, series, or compilation is completed.

Across Five Aprils – Hunt, Irene

Adventures of Sherlock Holmes – Doyle, Arthur Conan

The Adventures of Tom Sawyer – Twain, Mark

The Bridge of San Luis Rey – Wilder, Thornton

Call it Courage – Sperry, Armstrong

The Call of the Wild – London, Jack

A Christmas Carol – Dickens, Charles

The Count of Monte Cristo – Dumas, Alexander

A Day No Pigs Would Die – Peck, Robert Newton

Diary of a Young Girl – Frank, Anne

Dragonwings – Yep, Laurence

Enchantress from the Stars – Engdahl, Sylvia Louise

The Endless Steppe – Hautzig, Esther

Fahrenheit 451 – Bradbury, Ray

Frankenstein – Shelley, Mary

The Ghost Belonged to Me – Peck, Richard

The Giver – Lowry, Lois

Goodbye, Mr. Chips – Hilton, James

The Hobbit – Tolkien, J.R.R.

The Hunchback of Notre Dame

Hugo, Victor

Incident at Hawk’s Hill – Eckert, Allan W.

Island of the Blue Dolphins – O’Dell, Scott

Ivanhoe – Scott, Sir Walter

Jacob Have I Loved – Paterson, Katherine

Johnny Tremain – Forbes, Esther

Journey to Topaz – Uchida, Yoshiko

Julie of the Wolves – George, Jeanne Craighead

Kim – Kipling, Rudyard

The Last Mission – Mazer, Harry

The Last of the Mohicans – Cooper, James Fenimore

Le Morte d’Arthur – Malory, Sir Thomas

The Legend of Sleepy Hollow

Irving, Washington

The Little Prince Saint-Exupery, Antoine de

Little Women – Alcott, Louisa May

The Merry Adventures of Robin Hood – Pyle, Howard

My Friend Flicka – O’Hara, Mary

Narrative of the Life of Frederick Douglass – Douglass, Frederick

National Velvet – Bagnold, Enid

The Outsiders – Hinton, S.E.

The Pigman – Zindel, Paul

The Pilgrim’s Progress – Bunyan, John

The Red Pony – Steinbeck, John

Rifles for Watie – Keith, Harold

Rip van Winkle – Irving, Washington

Robinson Crusoe – Defoe, Daniel

Roll of Thunder, Hear My Cry – Tylor, Mildred D.

Shane – Schaefer, Jack

Story of My Life – Keller, Helen

A Stranger Came Ashore – Hunter, Mollie

Tales from Shakespeare – Lamb, Charles & Mary

The Thurber Carnival – Thurber, James

The Witch of Blackbird Pond

Speare, Elizabeth George

Treasure Island – Stevenson, Robert Louis

A Tree Grows in Brooklyn – Smith, Betty

20,000 Leagues under the Sea – Verne, Jules

The Upstairs Room – Reiss, Johanna

War of the Worlds – Wells, H.G.

Where the Red Fern Grows – Rawls, Wilson

The White Mountains – Christopher, John

A Wizard of Earthsea – LeGuin, Ursula K.

A Wrinkle in Time – L’Engle, Madeleine

The Yearling – Rawlings, Marjorie Kinnan

By signing below, we attest that _____________________________________ has read all of the books

marked as read on the list above.

________________________________

________________________________

Reader’s signature

Parent’s signature

Return with order form to the Mensa Foundation, 1229 Corporate Drive West, Arlington, Texas 76006-6103,

fax to 817-649–5232 or scan to ReaderAward@mensafoundation.org.

©The Mensa for Kids Excellence in Reading Award program is the property of the Mensa Education & Research Foundation, www.mensafoundation.org. The program is provided as a complimentary service to the public. Reproduction and distribution without modification is allowed. Images, links and linked content referenced herein are the property of the originating entities.

Mensa for Kids Excellence in Reading Award Program

List 4: Grades 9–12

Please check off each box as the book, series, or compilation is completed.

Abraham Lincoln – Sandburg, Carl

Adventures of Huckleberry Finn – Twain, Mark

The Aeneid – Virgil

Against all Hope – Valladares, Armando

The Age of Innocence – Wharton, Edith

All Quiet on the Western Front – Remarque, Erich

All the King’s Men – Warren, Robert Penn

An American Tragedy – Dreiser, Theodore

Animal Farm – Orwell, George

Anna Karenina – Tolstoy, Leo

The Autobiography of Benjamin Franklin – Franklin, Benjamin

Babbitt – Lewis, Sinclair

Barchester Towers – Trollope, Anthony

Beowulf – Anonymous

Brave New World – Huxley, Aldous

The Caine Mutiny – Wouk, Herman

Candide – Voltaire

The Canterbury Tales – Chaucer, Geoffrey

The Catcher in the Rye – Salinger, J.D.

The Cherry Orchard – Chekhov, Anton

The Chosen – Potok, Chaim

Collected Short Stories – Welty, Eudora

The Concise Columbia Book of Poetry

Crime and Punishment – Dostoevsky, Fyodor

The Crucible – Miller, Arthur

The Cruel Sea – Monsarrat, Nicholas

Cyrano de Bergerac – Rostand, Edmond

Darkness at Noon – Koestler, Arthur

A Death in the Family – Agee, James

The Divine Comedy – Dante

Doctor Zhivago – Pasternak, Boris

A Doll’s House – Ibsen, Henrik

Don Quixote – Cervantes, Miguel de

Fathers and Sons – Turgenev, Ivan

Dr. Faustus – Marlowe, Christopher

For Whom the Bell Tolls – Hemingway, Ernest

The Forsyte Saga – Galsworthy, John

The Fountainhead – Rand, Ayn

Go Tell It on the Mountain – Baldwin, James

The Good Earth – Buck, Pearl

Great Expectations – Dickens, Charles

The Great Gatsby – Fitzgerald, F. Scott

Gulliver’s Travels – Swift, Jonathan

Hamlet – Shakespeare, William

A Handful of Dust – Waugh, Evelyn

The Heart is a Lonely Hunter – McCullers, Carson

How Green Was My Valley – Llewellyn, Richard

I Know Why the Caged Bird Sings – Angelou, Maya

I, Claudius – Graves, Robert

Inherit the Wind – Lawrence, Jerome and Robert E. Lee

Invisible Man – Ellison, Ralph

The Iliad – Homer

Jane Eyre – Brontë, Charlotte

The Jungle – Sinclair, Upton

King Lear – Shakespeare, William

Les Misérables – Hugo, Victor

Long Day’s Journey into Night – O’Neill, Eugene

Look Homeward, Angel – Wolfe, Thomas

Lord Jim – Conrad, Joseph

Lord of the Flies – Golding, William

The Lord of the Rings Trilogy – Tolkien, J.R.R.

Madame Bovary – Flaubert, Gustave

The Magic Mountain – Mann, Thomas

A Man for All Seasons – Bolt, Robert

Moby-Dick – Melville, Herman

Moll Flanders – Defoe, Daniel

The Moonstone – Collins, Wilkie

Much Ado About Nothing – Shakespeare, William

Murder in the Cathedral – Eliot, T.S.

My Ántonia – Cather, Willa

Native Son – Wright, Richard

Night – Wiesel, Elie

The Nine Tailors – Sayers, Dorothy

1984 – Orwell, George

The Odyssey – Homer

Oedipus Rex – Sophocles

Of Human Bondage – Maugham, Somerset

Of Mice and Men – Steinbeck, John

The Once and Future King – White, T.H.

One Day in the Life of Ivan Denisovich – Solzhenitsyn, Alexander

Our Town – Wilder, Thornton

©The Mensa for Kids Excellence in Reading Award program is the property of the Mensa Education & Research Foundation, www.mensafoundation.org. The program is provided as a complimentary service to the public. Reproduction and distribution without modification is allowed. Images, links and linked content referenced herein are the property of the originating entities.

 

Mensa for Kids Excellence in Reading Award Program

 

 

A Passage to India – Forster, E.M.

The Best Short Stories of O. Henry

The Picture of Dorian Gray – Wilde, Oscar

(Modern Library Edition) – Henry, O.

Portrait of the Artist as a Young Man

The Stranger – Camus, Albert

Joyce, James

A Streetcar Named Desire – Williams,

The Power and the Glory – Greene, Graham

Tennessee

Pride and Prejudice – Austen, Jane

Tess of the D’Urbervilles – Hardy, Thomas

Profiles in Courage – Kennedy, John F.

A Town Like Alice – Shute, Nevil

Pygmalion – Shaw, George Bernard

Their Eyes Were Watching God

Rabbit, Run – Updike, John

Hurston, Zora Neale

The Red Badge of Courage – Crane,

Things Fall Apart – Achebe, Chinua

Stephen

To Kill a Mockingbird – Lee, Harper

The Scarlet Letter – Hawthorne, Nathaniel

To the Lighthouse – Woolf, Virginia

The School for Scandal – Sheridan,

Tom Jones – Fielding, Henry

Richard B.

The Trial – Kafka, Franz

Short Stories – Poe, Edgar Allan

The Turn of the Screw – James, Henry

Silas Marner – Eliot, George

Uncle Tom’s Cabin – Stowe, Harriet

A Single Pebble – Hersey, John

Beecher

Sonnets – Shakespeare, William

Vanity Fair – Thackeray, William M.

Sons and Lovers – Lawrence, D.H.

Villette – Brontë, Charlotte

The Sound and the Fury – Faulkner, William

Walden – Thoreau, Henry David

Steppenwolf – Hesse, Hermann

Wuthering Heights – Brontë, Emily

By signing below, we attest that _____________________________________ has read all of the books

marked as read on the list above.

________________________________

________________________________

Reader’s signature

Parent’s signature

Return with order form to the Mensa Foundation, 1229 Corporate Drive West, Arlington, Texas 76006-6103,

fax to 817-649–5232 or scan to ReaderAward@mensafoundation.org.

©The Mensa for Kids Excellence in Reading Award program is the property of the Mensa Education & Research Foundation, www.mensafoundation.org. The program is provided as a complimentary service to the public. Reproduction and distribution without modification is allowed. Images, links and linked content referenced herein are the property of the originating entities.

Mensa for Kids Excellence in Reading Award Program

Earn a commemorative certificate in recognition of your outstanding achievement and get an Excellence in Reading T-shirt, too!

The Mensa Foundation recognizes and

encourages education, gifted youth and lifelong learning through programs like the Mensa for Kids Web site and other activities.

To encourage the joy of reading among gifted youth, the Foundation has developed the Mensa for Kids Excellence in Reading Award Program!

As each list is completed, fill out the form below and return with the completed list to:

PDF or scan and email to ReaderAward@mensafoundation.org

Mail to

Excellence in Reading, Mensa Foundation

1229 Corporate Drive West, Arlington, Texas 76006-6103

Fax to 817-649–5232

Gifted youth’s full name

 

 

Mensa member # (if applicable)

 

 

 

 

Address, city, state, ZIP code

 

 

 

 

 

Email address

Phone #

 

(

) –

 

 

Youth’s name to appear on certificate

Youth’s shirt size (if requested)

 

4T S M L Adult S Adult M

 

 

Parent’s name

Mensa member # (if applicable)

 

 

 

 

Email address, if different from above

 

 

 

 

 

 

 

I would like to subscribe to the BRIGHT enewsletter for smart kids. Mensa For Kids' Bright is the smartest monthly eNewsletter for kids ages 6-10 and includes fun games, puzzles, activities and factoids specially selected to encourage children to learn, explore and think outside the box.

I would like email updates about the Mensa Foundation and its activities.

I would like email updates about American Mensa.

©The Mensa for Kids Excellence in Reading Award program is the property of the Mensa Education & Research Foundation, www.mensafoundation.org. The program is provided as a complimentary service to the public. Reproduction and distribution without modification is allowed. Images, links and linked content referenced herein are the property of the originating entities.

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Completing section 1 of mensa iq test certificate

2. Once the previous array of fields is finished, you need to include the required specifics in George and Martha Marshall James, Chinua, The Hundred Dresses Estes, Ingalls, Little Toot Gramatky Hardie The, Robert, The Polar Express Chris Van, Stupid Tales Scieszka Jon, Stone Soup Brown Marcia Tale of, Steig William, The Tale of Peter Rabbit Potter, Maurice, WinniethePooh Milne AA, By signing below we attest that, and Parents signature so that you can go further.

Stage # 2 for submitting mensa iq test certificate

3. This subsequent step should also be rather straightforward, Please check off each box as the, Alice in Wonderland Carroll, Chronicles of Prydain Alexander, entire series as listed below, The Book of Three The Black, A Dog on Barkham Street Stolz, Jacqueline, From the Mixedup Files of Mrs, Frankweiler Konigsburg EL, Gentle Ben Morey Walt Hatchet, Dodge Mary Mapes, Harriet the Spy Fitzhugh Louise, Virginia, and The Jungle Book Kipling Rudyard - every one of these form fields needs to be completed here.

Gentle Ben  Morey Walt  Hatchet, From the Mixedup Files of Mrs, and Alice in Wonderland  Carroll in mensa iq test certificate

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The Dark is Rising Sequence, Lewis CS entire series as listed, and Hodgson in mensa iq test certificate

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mensa iq test certificate completion process detailed (stage 5)

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