DATE ___________________
NAME ____________________________________ SOCIAL SECURITY NO _____________
STREET _____________________________________________________________________
CITY, STATE, ZIP _____________________________________________________________
TELEPHONE NUMBERS: HOME __________________ WORK _______________________
GRADUATION DATE (ACTUAL OR EXPECTED) __________________________________
MAJOR FIELD OF STUDY ______________________________________________________
MINOR FIELD OF STUDY ______________________________________________________
ECO COURSES COMPLETED:
ECO COURSES CURRENTLY TAKING:
APPROXIMATE GPA IN ECO COURSES: ________ OVERALL GPA: ________
Are you willing to help in our activities? If so, when? (Circle all that apply)
Are there any activities that the chapter could organize that might interest you?