FRATERNITY RECRUITMENT REGISTRATION

PERSONAL INFORMATION
Name: Blackboard Username:
Preferred Name:
Home/Permanent Address:
Campus/Local Address:
Residence Hall & Room #: Email address:
Campus/Local Telephone #: ( ) - Cell #: ( ) -

ACADEMIC INFORMATION
Class Year Classification (circle one): First-year Sophomore Junior
Senior
Major: Minor:
Quinnipiac University cumulative GPA: Total completed credits:
Are you a transfer student?:
If yes, please list previously attended institution(s):

INVOLVEMENT INFORMATION (You may use the back of this sheet if necessary.)
Please list all high school & college activities:

Please list all community involvement:

Please list any honors, awards, or additional information:

FRATERNITY INFORMATION
Have you ever been a member of a national collegiate fraternity/sorority?
If yes, which one? Where?
Date joined: Date terminated:
Please list any immediate family members in fraternities (including uncles and grandfathers)
Name Relationship Fraternity
Name Relationship Fraternity

I hereby certify that the above information is correct.

I understand that in order to be eligible to receive a bid, I must be a regularly enrolled, full-time undergraduate student in
good standing at Quinnipiac University with a 2.25 or better cumulative GPA. I authorize Quinnipiac University to verify my
academic eligibility.
By signing below, I agree to the terms listed above and allow my registration information to be made available to the
Quinnipiac University Greek chapters as part of the recruitment process.

Signature: Date: