GENERAL INFORMATION

Full Name:
Permanent Address:
(Street,
City, Province,
Postal Code)
School Address:
(Street,
City, Province,
Postal Code)
Summer Phone Number:
Email Address:

LETTERS OF RECOMMENDATION

Name:
Relationship:
Name:
Relationship:

ACADEMIC INFORMATION

University Attending in the Fall:
Program:
Post-Secondary Degrees Already Achieved:

SIGMA CHI HISTORY

Chapter:
Month/Year of Initiation:
List the Offices you've held in Sigma Chi:
Please list your activities outside of Sigma Chi in which you are/have been involved. You are encouraged to outline some of your accomplishments from these activities. Use the space provided below.
Please list any Honours & Awards you have received, including a short description of each. Use the space provided below.

Signature

Date

Typing you name will be treated as the equivalent of signing your name.