Fill - Free fillable Newmemberfall2017 Southeastern Louisiana University Greek Life PDF form

New Member Roster and Initiation Verification Form

This form is due within three business days following the completion of Recruitment/Intake. The Assistant Director for Student

Engagement must approve this form before any New Member Education process can begin and for Initiation may occur.

Organization/Chapter:

Date:

By signing this document you agree to the following

 Academic Release- I wish to waive my rights granted to me by the Family Educational Rights and Privacy Act of 1974 and

permit Southeastern Louisiana University to release academic information about me to my respective Sorority/Fraternity,

respective organization national office, Southeastern Louisiana University awards committee, or any other designated party with

a legitimate educational interest. I understand that this waiver will be in effect until I notify the Office for Student Engagement

that I no longer wish to allow such information to be released.

 Housing- I acknowledge that I will be charged a $105.00 non-refundable parlor fee if my fraternity/sorority has a house in the

Village. The parlor fee will be applied regardless of personal place of residency. I further acknowledge that I am responsible

for ensuring my respective organization updates my membership status with the Office for Student Engagement.

 Enrollment Requirement: I must be enrolled and continue to be enrolled as a full-time student and meet all minimum grade

point average requirements in order to be initiated.

Name (typed)

Student ID #

Signature

Date

CUM

GPA

(Office

Use)

Hrs.

Enr

(Office

Use)

Initiation

Approval

(Office Use)

For Office Use Only:

Date Received: ____________ Date Entered into System: __________ Asst Director: ________________________________

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