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| Personal Information |
| Last, First Middle: | , | Social Security #: | |
| Address: | | Birthday: | (YYYY-MM-DD) |
| City, State Zip: | , | Home Phone: | |
| Email Address: |
Gender: |
Cell Phone: | |
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| Parent/Guardian Information |
| Last, First: | , | Relationship: | |
| Address: | | Phone: | |
| City, State Zip: | , | Country: | |
| Email Address: | |
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| Last, First: | , | Relationship: | |
| Address: | | Phone: | |
| City, State Zip: | , | Country: | |
| Email Address: | |
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| High School Information |
| School Name: | | Year Graduated: | (YYYY) |
| Address: | | Class Rank: | |
| City, State Zip: | , | Total Students: | |
| GPA: |
GPA Scale:
SAT Score: ACT Score: |
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| High School Activities: |
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| College Information |
| Student ID: |
Residence Hall: |
Dorm Room #: | |
| Classification: | Major: Hours Completed: GPA: |
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| College History |
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| College Activities: |
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| Special Needs: |
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| Recruiment History |
| Have you ever participated in Fraternity Recruitment before? Yes No |
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If yes, where:
Date: |
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| Did you sign a preference card? Yes No |
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| Have you ever pledged an IFC Fraternity before? Yes No |
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If yes, University: Chapter:
Date: |
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| Family Fraternity History |
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| Miscellaneous Information |
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| Area of Special Study, Certification or Training: |
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| Community Activities: |
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| Attach Photo: |
Preferred Name: |
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| I certify the above information is true and correct. Electronic Signature: |
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