First Name:

Last Name:

Middle Name:

DU Email:

DU ID #:

Phone #:

Birthday (MM/DD/YYYY):

Parent Guardian:

Permanent Address (Street/Apt.):

Permant Address (City):

Permant Address (State):

Permant Address (Zip Code):

Permant Phone Number:

School Address (Street/Apt.):

School Address (City, State, Zip):

School Phone:

High School(s) Attended:

High School Graduation Date:

High School GPA: on a scale of

SAT score: ACT score:

Expected Major at DU:


DU class standing as of Fall 2005 (ie. First Year, Sophomore, Junior, Senior) :


Are you a Transfer Student?
Yes
No

Gender?
Male
Female

Have you ever pledged to a fraternity or sorority?
Yes
No

If yes, what organization and where?


If you have any relatives who were in fraternities or sororities, please note them here. (Name, Relation, Chapter, University)  


Please list any leadership positions held and honors you have received in high school and/or college. Include community service, BUT DO NOT send a resume