COLLEGIATE MEMBERSHIP APPROVAL FORM

	COLLEGIATE MEMBERSHIP APPROVAL FORM
	PHI BETA SIGMA FRATERNITY, INC.
Fill in the form and print the next page. SCHOOL DATE

THIS STUDENTS LISTED BELOW HAVE APPLIED FOR MEMBERSHIP IN PHI BETA SIGMA FRATERNITY, INC.

THE APPROVED STUDENTS MEET THE SCHOOL CRITERIA FOR MEMBERSHIP.

CANDIDATE NAME	GPA	COMPLETED BY UNIVERSITY APPROVED/DISAPPROVED	COMPLETED BY REGIONAL DIRECTOR APPROVED/DISAPPROVED	SELECTED BY CHAPTER YES/NO
		___________________	___________________
		___________________	___________________
		___________________	___________________
		___________________	___________________
		___________________	___________________
		___________________	___________________

		Signature	_____________________________
			DIRECTOR OR DEAN OF STUDENTS
Signature	_______________________________	Signature	_____________________________
	CHAPTER ADVISOR		REGIONAL DIRECTOR

UNIVERSITY/COLLEGE DEAN OF STUDENTS - THE TOP COPY OF THIS FORM TO THE INTERNATIONAL HEADQUARTERS: SEND 2^ND AND 3^RD COPY TO THE REGIONAL DIRECTOR: 4^TH COPY IS RETAINED BY THE CHAPTER

NAME OF REGIONAL DIRECTOR
ADDRESS
CITY
STATE
ZIP
PHONE#

INFORMATION TO BE FILLED IN BY CHAPTER

Chapter Name
Location
Region
Mailing Address
City
St
Zip
Contact Person
Phone #
Phone #