(Please Type or Print)

Name (First, Middle, Last):_______________________________________ Social Security #:______________

Chapter:__________________________________________ Member since (year)_______________________

Campus Address:___________________________________________________________________________

__________________________________________________Effective Until:___________________________

E-mail Address:_____________________________________

School Phone #:____________________________________Home Phone #:___________________________

Permanent Address:_________________________________________________________________________

_________________________________________________________________________________________

Academic Major:__________________________________ Expected Graduation:________________________

Credit Hours Completed:____________________________ Cumulative Grade Point Average:______________

Previous Semester Credit ours:______________________ Previous Semester GPA:____________________

In order of importance to you, please list all offices or positions held. If title is not self-explanatory, please describe in Description of Role/Responsibility.

Position	Begun	Ended	Description of Role/Responsibility

 

 

In order of importance to you, please list all offices, committee chairmanships, committee assignments, participation, etc. within the Greek community. If title is not self-explanatory, please describe in Description of Role/Responsibility.

Position	Begun	Ended	Description of Role/Responsibility

 

In order of importance to you, please list other campus organizations (other than fraternal) to which you belong and offices held. Please provide explanations as necessary to assist the selection committee.

Organization/Affiliation	From	To	Offices Held	From	To

 

 

In order of importance to you, please list your involvement in community and service to others. Please provide explanations as necessary to assist the selection committee.

 

 

In order of importance to you, please list any honors/awards/special achievements and designate what type of award (i.e. academic, social activity, service, etc.)

Honor or Award	Description	Presented By	Year

 

 

Please attach a 250 word, typewritten response to the following question, "Why are you seeking membership to the Order of Omega?"

 

 

I hereby consent to the release of my academic records for exclusive use by the Order of Omega selection committee, for purposes of membership consideration to the Sigma Gamma Chapter of the Order of Omega.

 

Date ; ; Signature

All applications and supporting material should be submitted to the Office of Student Life by December 8, 2004.