Please complete the following fields to be considered for the summer internship.

Required fields are marked by *.

Full Name* School Name Chapter Alpha-University of Illinois Beta-Ohio State University Gamma-Pennsylvania State University Delta-Purdue University Epsilon-North Dakota State University Zeta-Cornell University Eta-Iowa State University Theta-University of Missouri Iota-University of Wisconsin-Madison Kappa-University of Nebraska Lambda-University of Minnesota Nu-North Carolina State University Xi-Auburn University Omicron-University of Kentucky Pi-Oklahoma State University Rho-Colorado State University Sigma-Washington State University Tau-Michigan State University Phi-University of California-Davis Chi-Cal Poly State University-SLO Psi-University of Maine Omega-University of New Hampshire Alpha Alpha-West Virginia University Alpha Beta-Oregon State University Alpha Gamma-University of Florida Alpha Delta-Montana State University Alpha Epsilon-Louisiana State University Alpha Zeta-Kansas State University Alpha Eta-University of Georgia Alpha Theta-University of Maryland Alpha Iota-University of Arkansas Alpha Kappa-University of Tennessee-Knoxville Alpha Lambda-New Mexico State University Alpha Nu-University of Connecticut Alpha Pi-University of Arizona Alpha Rho-University of Vermont Alpha Sigma-California State University-Fresno Alpha Tau-Western Illinois University Alpha Upsilon-University of Tennessee-Martin Alpha Phi-South Dakota State University Alpha Chi-Western Kentucky University Alpha Psi-University of Wisconsin-River Falls Alpha Omega-Murray State University Beta Alpha-Southern Illinois University Beta Gamma-University of Wisconsin-Platteville Beta Delta-Illinois State University Beta Epsilon-Arkansas State University Beta Zeta-Clemson University Beta Eta-Virginia Polytechnic Institute & SU Beta Theta-Middle Tennessee State University Beta Iota-Truman State University Beta Kappa-California State University-Chico Beta Lambda-Texas A & M University-Commerce Beta Mu-Austin Peay State University Beta Nu-Texas A & M University Beta Xi-Texas Tech University Beta Omicron-University of Wyoming Beta Pi Colony-Louisiana Tech University Beta Rho-Northwest Missouri State University Beta Sigma-Tarleton State University Beta Tau-Mississippi State University Beta Upsilon-University of Delaware Beta Phi-University of Idaho Beta Chi-Stephen F. Austin State University Beta Psi-Delaware Valley College Beta Omega-Missouri State University Gamma Alpha-Florida Southern College Gamma Beta-Fort Hays State University Gamma Gamma-Southern Arkansas University Gamma Delta-Abraham Baldwin Agricultural College None Pin Number Initiation Date Expected Graduation Date Major Cell Phone Number Email Address

EDUCATION

List the high school(s) and college(s) you have attended, including the institution name, location, years attended and degree earned, if applicable.

Institution #1 Institution #2 Institution #3

EXPERIENCE

List chronologically the most recent positions you have held.

Position #1

Job Title Firm Salary ($___ per _______) Employed from _______ to _______ Supervisor

Position #2

Job Title Firm Salary ($___ per _______) Employed from _______ to _______ Supervisor

FRATERNITY SERVICE

List all Chapter Offices held, elected and appointed. Include Office and dates held. Do you feel you have leadership skills? Please explain. If so, when? If so, when? Other Chapters visited (and for what occasion) List any interfraternity activity, IFC regional or national meetings attended. When would it be possible for you to start if hired? If so, when? What are your career objectives?

LETTER OF APPLICATION

PERSONAL FACTS

Date of Birth* Place of Birth What are your talents? What organizations do you belong to? Campus positions held and honors achieved. Cumulative scholastic average in college (___ on a ___ rating scale): Indicate public speaking ability and/or experience. Indicate computer experience and/or training including experience with websites. Indicate any recruitment experience you have (especially pre-freshman and summer recruitment). Why do you think you could be good at recruitment? Why are you interested in an internship with the National Fraternity? Explain how you represent the AGR Brand, Promise and Values.

REFERENCES

Give the names, job titles, addresses and phone numbers of four persons who are qualified to tell of your character, scholarship, personality, and general ability, and to whom you are will that we contact. Please include: a member of the faculty or administration of your college, the Chapter Adviser or other Alumnus, a businessman and a personal reference. You may also send letters from any of these.

REFERENCE #1

Name Job Title* Phone Number

Reference #2

Name Job Title Phone Number

Reference #3

Name Job Title Phone Number

Reference #4

Name Job Title Phone Number

PHOTOGRAPH