Thank you for your interest in Phi Beta Sigma Fraternity, Inc.

In order to fill out this Membership Application properly, you will need to have the latest version of Adobe Acrobat Reader on your computer. The latest version of Adobe Acrobat Reader is available HERE.

After you fill out the Membership Application Pages, the completed Membership Application Form will be launched within Adobe Acrobat Reader. At this time you can either save the file to your local machine or print it from Adobe Acrobat Reader.

Carefully review the form making sure that all information is complete and accurate. An incomplete application may be rejected or may be delayed for processing.

In order to submit the Membership Application Form, please print the completed Membership Application Form, sign the bottom and submit to the chapter of interest along with your mandatory, non-refundable fee of $100.00 by way of Money Order or Certified Check from your financial institution.

General Information

Name:







Primary Phone:
Daytime Phone:
Fax:
Personal Email:
Business Email:

Private Information

Date of Birth:
/ 
/ 

Place of Birth:


Ethnicity: Check All That Apply







Home Address:






Marital Status:

Spouse:




Nearest relative/friend:













Private Information

Are you currently employed?



Hobbies:

Organizational Affiliations:
(professional, social (non-fraternal), service-oriented or Masonic)
1.
2.
3.
4.

Leadership Roles:
Describe any leadership roles held in these organizations (e.g. position/term/duties)
Have you ever applied for membership into or been rejected by another college fraternity?





Is your father, brother or son a member of Phi Beta Sigma Fraternity?


Does anyone in your family belong to another Greek lettered organization?

If so, Who?




Educational Information

Are you currently a student?

For Collegiate Applicants Only
Name of the Institution:

Are you attending the college/university where this chapter is located?

Degree Type Sought:
(e.g. B.S. or M.Ed.)

Major of Study:

Minor (if any):

Current Cumulative GPA:

Number of Hours Completed:

Expected Graduation:
  /  


Career Objective:


For Alumni Applicants Only
Academic History:
1)
Name of Institution:

Degree Type Sought or Earned:
(e.g. B.S. or M.Ed.)

Major of Study:

Minor (if any):

Final Cum. or Graduating GPA:

Hours Completed:

Was degree conferred?

If yes, date conferred:
 / 
mm

YYYY


2)
Name of Institution:

Degree Type Sought or Earned
(e.g. B.S. or M.Ed.):

Major of Study:

Minor (if any):

Final Cum. or Graduating GPA:

Hours Completed:

Was degree conferred?

If yes, date conferred:
 / 
mm

YYYY

References

Please list three references (not including relatives)
Reference 1













Reference 2













Reference 3