First Name:

Middle Initial:

Campus or Local Address:

Cell Phone:

Email Address:

Chapter Alpha Epsilon Pi Alpha Sigma Phi Delta Sigma Phi Phi Delta Theta Sigma Alpha Epsilon Sigma Nu Tau Epsilon Phi Theta Chi

Shirt Size:
XS S M L XL XXL XXXL

Are ou a member of your chapter's e-board?
Yes
No

If yes, what is your title?

Educational Major:

Class year Freshman Sophomore Junior Senior

Anticipated Graduation Date:
FallSpring 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Emergency Contact Information
(not greek affiliated I.E. Family member):

Contact Name:

Contact Cell Phone:

Permanent Home Phone:

Contact's Relationship to you:

You must read and agree to the following terms before submitting this form/application to the SCA office. Once the SCA office has your application, you are agreeing that you are indeed the person whose information on this application is true to the best of your ability. Any information that might be found to be false might be subjected to a judicial investigation conducted by the SCA office. Your Submission of this application is also and agreement that you give the SCA office and/or its designee permission to check your academic, social, judicial and financial records for accuracyand worthiness. You also understand that in order to participate in IFC and NPC activities and/or events, you must be a regularly enrolled, full-time student in good standing with the university with a minimum 2.1 cumulative GPA. In some cases each individual organization might have a higher GPA regarding involvement. You hereby authorize the University of Hartford to verify your academic eligibility. You further more agree that if you are found to be in violation of any university policies and/or procedures, your file will be forwarded to the judicial office for further action, if necessary.