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Manhood, Perseverance, Leadership, Achievement and True Brotherhood
Phi Delta Psi Fraternity Inc.
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PHI DELTA PSI CREED
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Home
About
Fraternity History
Founders’ History
Founders
Mission Statement
PHI DELTA PSI CREED
President’s Message
Current Board
Membership
Join Phi Delta Psi
Start A Chapter
Pay Your Dues
Membership Application
Refer A Potential Brother
Update Your Membership
Community Services
Phire Brand
S.A.F.E Initiative
Blog
News & Events
The Lion’s Den
Press Releases
Upcoming Events
Founders Day
CONTACT US
Membership Application
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Home
Membership
Membership Application
Membership Application
Your Details
First Name
*
Surname/Family Name
*
Home Address
*
City
*
State
*
Home/Zip
*
Primery Phone
*
Your Email
*
Personal Information
Martial Status
*
Nearest Relative/Friend
*
Relationship
Relative / Friend Address
Relative / Friend City
Relative / Friend State
Relative / Friend Zip
Relative / Friend Phone
Educational Information
Collegiate Applicants
First Choice
Second Choice
Third Choice
Current Student
Yes
No
Institution State
First Choice
Second Choice
Third Choice
Major of Study
Minor (if Any)
Current Cumulative GPA
Number of hours Completed
Expected Graduation Date
Career Objectives
Graduate Applicants
First Choice
Second Choice
Third Choice
Alumni Applicants
First Choice
Second Choice
Third Choice
Other Information
What Organizations Are You Affiliated With?
(Professional, Social (non-fraternal), Service-Oriented or Masonic)
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?
Yes
No
If Yes, Name of Fraternity
Do your have relatives who are members of Phi Delta Psi?
Yes
No
If Yes, Relative Name
Have you ever been convicted of a felony criminal offense?
Yes
No
If Yes, please explain
Military Information
Have you ever served in the U.S. Armed Forces
Yes
No
What Branch
Specialty
Date Entered
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Discharge Date
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1932
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1930
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1928
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1922
1921
1920
Health Information
Age
Height
Weight
Please list any medications that you take regularly?
(Including vitamins, and non-prescription medications)
Please describe any previous surgeries or hosipitalizations:
Personal Medical History
Alcohol
Drug Abuse
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