First Name
Middle Initial
Last Name
Gender	Male Female

Permanent Address:

Street
City
State	Alaska (AK) Arizona (AZ) Arkansas (AR) California (CA) Colorado (CO) Connecticut (CT) Delaware (DE) District of Columbia (DC) Florida (FL) Georgia (GA) Guam (GU) Hawaii (HI) Idaho (ID) Illinois (IL) Indiana (IN) Iowa (IA) Kansas (KS) Kentucky (KY) Louisiana (LA) Maine (ME) Maryland (MD) Massachusetts (MA) Michigan (MI) Minnesota (MN) Mississippi (MS) Missouri (MO) Montana (MT) Nebraska (NE) Nevada (NV) New Hampshire (NH) New Jersey(NJ) New Mexico (NM) New York (NY) North Carolina (NC) North Dakota (ND) Ohio (OH) Oklahoma (OK) Oregon (OR) Pennyslvania (PA) Puerto Rico (PR) Rhode Island (RI) South Carolina (SC) South Dakota (SD) Tennessee (TN) Texas (TX) Utah (UT) Vermont (VT) Virginia (VA) Virgin Islands (VI) Washington (WA) West Virginia (WV) Wisconsin (WI) Wyoming (WY)
Zip code

Current Address:

Same as permanent
Street
City
State	Alaska (AK) Arizona (AZ) Arkansas (AR) California (CA) Colorado (CO) Connecticut (CT) Delaware (DE) District of Columbia (DC) Florida (FL) Georgia (GA) Guam (GU) Hawaii (HI) Idaho (ID) Illinois (IL) Indiana (IN) Iowa (IA) Kansas (KS) Kentucky (KY) Louisiana (LA) Maine (ME) Maryland (MD) Massachusetts (MA) Michigan (MI) Minnesota (MN) Mississippi (MS) Missouri (MO) Montana (MT) Nebraska (NE) Nevada (NV) New Hampshire (NH) New Jersey(NJ) New Mexico (NM) New York (NY) North Carolina (NC) North Dakota (ND) Ohio (OH) Oklahoma (OK) Oregon (OR) Pennyslvania (PA) Puerto Rico (PR) Rhode Island (RI) South Carolina (SC) South Dakota (SD) Tennessee (TN) Texas (TX) Utah (UT) Vermont (VT) Virginia (VA) Virgin Islands (VI) Washington (WA) West Virginia (WV) Wisconsin (WI) Wyoming (WY)
Zip code

Contact information:

IM Screen Name (optional)
E-mail Address
Phone	()

Fraternities

Alpha Epsilon Pi
Alpha Phi Alpha Fraternity, Inc.
Delta Sigma Phi
Kappa Delta Rho
Lambda Alpha Upsilon, Fraternity Inc.
Lambda Upsilon Lambda Fraternity, Inc
Omega Psi Phi Fraternity, Inc.
Phi Beta Sigma Fraternity, Inc
Phi Delta Theta
Phi Iota Alpha Fraternity, Inc
Phi Kappa Psi
Phi Kappa Tau
Pi Delta Psi Fraternity, Inc.
Sigma Alpha Epsilon
Sigma Alpha Mu
Tau Kappa Epsilon
Triangle Fraternity


Sororities

Alpha Kappa Alpha Sorority, Inc.
Alpha Sigma Alpha
Alpha Sigma Theta
Alpha Xi Delta
Delta Phi Epsilon
Delta Sigma Theta Sorority, Inc.
Lambda Pi Chi Sorority, Inc.
Omega Phi Beta Sorority, Incorporated
Sigma Lambda Upsilon Sorority, Inc.
Sigma Sigma Sigma
Zeta Phi Beta Sorority, Inc.
Zeta Tau Alpha