Full Name:

Hometown/High School:

Major:

College G.P.A.:

High School G.P.A.:

Campus Address:

E-mail :

Cell Phone Number:

High School Activities/College Activities (include any sports, clubs, other areas of involvement, or any areas of interest of involvement):

Leadership Experience:

Honors/Achievements/Awards:

Community Service/ Volunteer work:

Any relatives a part of a fraternity? If so, which?