Academic Verification Form
 Request for Information

  AGREEMENT

give my permission to the Registrar’s Office of to release my cumulative grade point average and credits to the members of the chapter of PHI BETA SIGMA FRATERNITY, INC.

 Signature: ____________________________________________________________

DATE:

This form must be completed and submitted with the official student membership approval form to the appropriate university official.

PBS –5 REVISED (8/90) TOP COPY TO REGISTRARS OFFICE: SEND COPY FOR NATIONAL OFFICE: 3^RD COPY TO CHAPTER

                                          THIS FORM MUST BE MAINTAINED IN THE CHAPTER FILES FOR 3 YEARS.