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Phi Mu Fraternity - Potential New Member Reference Form
NOTE: This is a confidential form, for use only by members of Phi Mu. If possible, attach a photograph and leadership/activities resume from the potential member. Even if you do not wish to endorse the potential member for membership, please complete as thoroughly as possible and return to the collegiate chapter, attention Membership Director. Visit chapterlocator for chapter contact information. You may use additional pages and attach them to this form if necessary.
Potential New Member’s Information
|Name | |
| |Last First Middle |
|Home Address | |
| |Street City State |
| |Zip |
|Telephone | |E-mail | |
| | |Address | |
| | | | |
|College/University Attending | |Birthday | |
| | | |MM/DD/YYYY |
| | |(123) 555-1212 |
|Classification | Freshman Sophomore Junior Senior |
| | |
|Parent(s) or guardian(s) | |
| | |
|High School | |
| | |
|Year Graduated | |Size of Class | |*Rank in Class | |
| | | | | | |
|*Cumulative GPA | |ACT Score | |SAT Score | |
| | |(If available) | |(If available) | |
|Please list potential member’s| |
|siblings, including ages, | |
|college attending, and Greek | |
|affiliations | |
| | |
| | |
| | |
| | |
|Please list potential member’s| | | | | | |
|Phi Mu relatives (full name, | | | | | | |
|including maiden) | | | | | | |
| |Full Name |Relationship |Address |City |State |Zip |
| |(including maiden) | | | | | |
| | | | | | | |
| |Full Name |Relationship |Address |City |State |Zip |
| |(including maiden) | | | | | |
| | | | | | | |
| |Full Name |Relationship |Address |City |State |Zip |
| |(including maiden) | | | | | |
| | | | | | | |
| |Full Name |Relationship |Address |City |State |Zip |
| |(including maiden) | | | | | |
*Under the Family Education Rights Act of 1974, written authorization is required from the potential member before any information
from an institution of higher education, college, school or other related organization may be obtained.
Leadership and Activities
Potential contribution to Phi Mu: (Please provide information about the potential member’s leadership ability, personality and character as it relates to contributions she could make to Phi Mu. Please include the potential member’s special talents, interests and any other information that will assist the chapter in getting to know her better.)
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Activities: (Please list names of organizations with the potential member’s participation and leadership in each one. Attach additional information on a separate sheet if necessary.)
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Other: (Please list anything else it would be important to know.)
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Phi Mu Recommendation
This form was: Solicited by chapter Sent voluntarily Solicited by the PNM
Classification of Information:
| |I am personally acquainted with the potential member and endorse her for membership. |
| |I am willing to have chapter membership selection board unanimously decide endorsement for this potential member since I do not know her personally, |
| |do not know her well or am a collegian. |
| | |
| |I am personally acquainted with potential member and do NOT endorse her for membership. If clarification is needed, the chapter adviser may contact |
| |me. |
| | |
| |I obtained unanimous approval by an Alumnae Panhellenic for this potential member and/or members of three other sororities (name them) who would |
| |recommend this potential member to their chapters, thereby constituting an endorsement for membership. |
| | |
| | |
|Completed by | |Chapter of | |Year Initiated | |
| | |Initiation | | | |
| |Full Name (including maiden) | | | | |
|E-mail | |Telephone | |
| | | |(123) 555-1212 |
|Address | | | | |
| |Street |City |State |Zip |
|Are you a current member | Alumnae Chapter | | Chapter Association | | Forever Faithful |
|of a(n) | | | | | |
|If so, please list alumnae| |
|chapter and/or chapter | |
|association | |
| | |
| | |
| | |
|Check all that apply |
| Alumna | Collegian (info only) | Foundation Member |
| | |Foundation Giving Program Member: |
| | |- 1852 Society |
| | |- Legacy League |
| | |- Carnation Club |
| | |- Rose and White |
| Current or former national/area officer |List position(s) & year held | |
| Advisory Council member |List chapter & position on council | |
| | | |
| | | | |
|Signature | |Date | |
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PLEASE INCLUDE A RECENT PHOTO &
LEADERSHIP ACTIVITIES RESUME
IF AVAILABLE
[pic]
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