Western Illinois University: Macomb Campus

Name:*

Campus Address:*

Primary Contact Phone Number:* (XXX-XXX-XXXX)

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Email Address:*

How do you prefer we contact you?:*
Text Message Phone Call Email

WIU ID #:* - -

GPA:* (2.5 cumulative GPA is required in order to join a fraternity.)

Class Standing:*
Freshman Sophomore Junior Senior Other

Fraternity Interested In:*
Alpha Gamma Rho Alpha Gamma Sigma Delta Sigma Phi
Delta Tau Delta Delta Upsilon Pi Kappa Alpha
Pi Kappa Phi Sigma Alpha Epsilon Sigma Chi
Sigma Pi Tau Kappa Epsilon Theta Xi
All Fraternities

What were you involved with in high school/college?

Electronic Signature:*
By clicking here, I hereby grant permission for the release of my grade and GPA information- while I am a member of my chapter- to the Office of Student Activities, my (inter)national Greek letter organization, Chapter President, Scholarship Chairs, Chapter Advisors, Chapter Executive Board, Membership Board, and IFC/UGC/PHC Presidents for the purposes of checking recruitment eligibility, awards and recognition, computing chapter academic averages, needs assessment, etc.