Alpha Gamma Xi Fall 2009 Membership Application

ALPHA GAMMA XI Fall 2009 Membership Application $15 Application Fee required APPLICANT INFORMATION Name: Date of birth:

House Phone

Applicants Cell Phone:

ZIP Code:

Grade Level:

Current address: City:

EDUCATION Please list the classes you took during the Fall 2009 semester. Please include your teacher’s names. 1st: 2A: 2B: 3rd: 4th:

GUARDIAN CONTACT INFORMATION Guardian(s) Name: Home Phone: Address:

Cell Phone:

City:

State:

ZIP Code:

Relationship: ACADEMIC AND DISCIPLINE INFORMATION GPA (weighted and un-weighted): Have you been suspended:

If yes please explain the situation:

Continued:

REFERENCES Name

Address

Phone

PLEASE ANSWER THE FOLLOWING SHORT ANSWERS ON A SEPARATE SHEET: What community service or church activities are you currently involved in?

What college aspirations do you wish to pursue? What would you like to major in?

Where do you see yourself in 5 years, 10 years, and 15 years?

What does being a member of ALPHA GAMMA XI mean to you?

SIGNATURES Parent/Guardian Signature: Signature of applicant:

Date:

Long Essay Alpha Gamma Xi’s motto is “Empowering others through respect, honor, and merit.” Write an essay on what this motto means to you and how you would execute this motto if you were to become a member of Alpha Gamma Xi. (250 word minimum; attach on a separate sheet. Double space, 12 point font and Times New Roman) Also on a separate sheet of paper list all clubs, organizations, and/or clubs you currently participate in. If you know in advance you will not be able to attend any dates given to you please e-mail us ASAP at: [email protected] The application fee is non-refundable and the money will be used to help pay for any required items during the process of becoming a member of ALPHA GAMMA XI.