Phi Beta Sigma Fraternity, Inc.

Nu Gamma Sigma Chapter - Bellville, IL

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Interest Form
  1. If you are interested in becoming a member of Phi Beta Sigma Fraternity, Inc. - Nu Gamma Sigma Chapter Alumni Chapter of Belleville, IL, we ask that you fill out the following questionnaire. You will be contacted via email immediately after submitting your interest form to acknowledge that it has been received. This database will be used to generate invitations to the chapter's next official informational and some informal gatherings.
  1. Prefix
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  2. First Name(*)
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  3. MI
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  4. Last Name(*)
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  5. Suffix
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  6. Address(*)
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  7. City(*)
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  8. State(*)
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  9. Zipcode(*)
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  10. Primary Phone(*)
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  11. Secondary Phone
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  12. Primary Email(*)
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  13. Secondary Email
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  1. Place of Birth(*)
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  2. Date of BIrth(*)
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  3. Ethnicity (Optional)
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  4. Marital Status
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  5. Currently Employed(*)
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  6. Name of Current Employer(*)
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  7. Occupation(*)
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  8. Hobbies/Interests
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  9. Organizational Affiliations (professional/ social/ service oriented/ Masonic)
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  10. Have you ever applied for membership into another college fraternity.(*)
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  11. Please state which organization and where? (Please state all instances)
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  12. Have you ever been rejected for membership into another college fraternity.(*)
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  13. Please state which organization, when, where, and ? (Please state all instances)
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  14. Are any of the following relations a member of Phi Beta Sigma? (check all that apply)
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  15. Does anyone else in your family belong to a Greek Lettered organization?
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  16. Please state their relation to you and the organization to which they belong
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  1. Are you a current student?(*)
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  2. Education Level(*)
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  3. Hours Completed
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  4. GPA (cumulative)
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  5. Please List ALL Institutions, Dates (ie F03-S05), and Major/Minor(*)
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  6. Please list all degrees, institutions, dates conferred, major, and minor (if applicable)
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