National Coed Business and Economics Fraternity

First Middle Last

Address: _____________________________________________________________________

Street City Zip Code

Home Phone: ______________Work Phone: _______________ Email: ___________________

Student ID#: _______________ Birth Date: ______________ Credits Completed: __________

Major: ______________________________ Minor: __________________________________

Cumulative GPA: _______ Expected Graduation Date (Semester & Year): _________________

Class Schedule: ________________________________________________________________

Name of Employer: _____________________________________________________________

Work Schedule: _______________________________________________________________

What Other School Organizations Are You Involved With? ______________________________

Why Do You Want To Join Phi Chi Theta? __________________________________________

What Can You Contribute To Phi Chi Theta? ________________________________________

Would You Be Willing To Join A Committee Or Take An Officer Position? ________________

Permission is granted to check my GPA and major for eligibility into Phi Chi Theta.

Signature

Date