BETA THETA PI’S

MEN OF PRINCIPLE SCHOLARSHIP APPLICATION

Please complete the following information.  By applying for this scholarship you are not committing yourself to membership in Beta Theta Pi or any other organization. 

First Name                                         Middle Name                                 Last Name

Permanent Address                                                       City                        State/Prov.            Zip/P.C                                           

Permanent Phone                                                                                       Cell  Phone (if applicable)

                                                                                                                Current Year:   Fr.  Soph.  Jun.  Sen.

Email address                                                                                              

Transfer Student:  Yes       No

         /         /                                                                                /

Date of Birth                  High School                                    Class Rank      H.S.GPA    ACT / SAT

Major_______________________

1Honors, Achievements, Awards________________________________________________

       _________________________________________________________________________

2 Extracurricular Activities (Community Service, Sports, Hobbies, etc.)

       ___________________________________________________________________________

       ___________________________________________________________________________

3 Future Plans______________________________________________________________

       ___________________________________________________________________________

I, _________________________ certify that all information contained in this application is accurate to the best of my knowledge.    

       Applicant’s Signature                                                                             Date