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Please use black or blue ink. Attach a separate sheet with additional information as necessary.

Personal Information: First and last name:

Current school address:

City State Zip Code

Phone number: E-mail address:

Permanent home address:

City State Zip Code

Academic Information: List any honors, awards and scholarships

Year in school: Freshman Sophomore Junior Senior Honors Program? Yes No

High School/College cumulative GPA ACT/SAT

Collegiate major: Minor:

Anticipated month/year of graduation:

Athletic Involvement: Indicate the type of intramural/recreational, varsity, junior varsity, etc.

Leadership Involvement: List all extracurricular activities and positions held.

Sigma Phi Epsilon Fraternity

MembershipApplication

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Sigma Phi Epsilon Fraternity

MembershipApplication

Return Application to:Sigma Phi Epsilon • Zollinger House • 310 S. Boulevard • P. O. Box 1901 • Richmond, VA 23219-1901

Community Involvement: List any community service organizations and your involvement:

Organization Position Years

Work or Internship Experience: List any work or internship experience:

Employer Position Years

Your views: What is your definition of a “Balanced Man?”

Signature: Date:

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