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PotentialNewMemberfo - Alpha Xi Delta Womens Fraternity

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PotentialNewMemberfo - Alpha Xi Delta  Womens Fraternity Powered By Docstoc
					               Mail completed potential member profiles directly to the Membership Vice President at the appropriate chapter (see current chapter addresses on
               back of form). You may attach additional information and letters of recommendation to this form. Complete the form with as much information
               about the woman as possible; you are not required to complete all fields. You can download this profile form and a chapter directory in the
               Alumnae Section, Potential New Member Recommendations link of www.alphaxidelta.org.


Name of potential
member:_____________________________________________________________________________________________________________
                          Last                       First                   Middle                  Preferred Name

Name of parent(s) or
guardian(s):____________________________________/____________________________________________________________________

Address of parent(s) or
guardian(s):_______________________________________________________________________________________________________
                                       Street                          City                    State            Zip

College or university attending:_________________________________________________ Year in college:                         __F     __So    __J    __SR

Campus
address:____________________________________________________________________________________________________________________
__

High school attended:____________________________________________________ Community where
located:_______________________________________

GPA:_____________________________ Rank in class:________________________                             Class
size:__________________________________________________

College attended after high school, if any:__________________________________________________
GPA:___________________________________________

Academic honors and
accomplishments:____________________________________________________________________________________________________

___________________________________________________________________________________________________________________________
_________


School and community activities. Include leadership positions (may attach additional
information):_____________________________________________________

___________________________________________________________________________________________________________________________
_________


Talents, hobbies and
interests:____________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________
_________


LEGACY INFORMATION
Alpha Xi Delta relatives (check all that apply): ____Mother/Stepmother          ____Grandmother/Step grandmother              ____Sister/Stepsisters         ____Aunt

Name of relative:____________________________________________ Initiating
chapter:___________________________________________________________

Phone: ( ______)
______________________________________________________________________________________________________________________


Address:____________________________________________________________________________________________________________________
__________
                                     Street                           City            State           Zip

Other Greek
influences:__________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________
__________
RECOMMENDATION INFORMATION
I recommend this woman   _____Yes   _____No   I have known her for _______ years.

Comments:__________________________________________________________________________________________________________________
___________

___________________________________________________________________________________________________________________________
___________


Completed by:
__________________________________________________________________________________________________________________________
                           Last                      First                   Middle                  Preferred Name

Address:____________________________________________________________________________________________________________________
___________
                                     Street                           City                    State           Zip

_____ Alumna _____ Collegian _____ Initiating
Chapter:_____________________________________________________________________________________
ALABAMA                       Theta Omicron/Embry-Riddle    MAINE                         NEW JERSEY                      Iota Zeta/Wingate University   Delta Kappa/Slippery Rock        Iota Alpha/George Mason
Epsilon Pi/Jacksonville State Alpha Xi Delta                Epsilon Rho/Southern Maine    Epsilon Lambda/Rider            Alpha Xi Delta                 University                       Alpha Xi Delta
Alpha Xi Delta                Membership Vice President     Alpha Xi Delta                University                      Membership Vice President      Alpha Xi Delta                   Membership Vice President
Membership Vice President c/o Student Activities            Membership Vice President     Alpha Xi Delta                  Campus Box 1652                Membership Vice President        Alpha Xi Delta-GMU
JSU P.O. Box 3044             600 S. Clyde Morris Blvd.     119 Brook Student Center      Membership Vice President       Wingate, NC 28174              B-105 University Union           4400 University Dr.
700 Pelham Road North         Daytona Beach, FL 32114       37 College Ave.               P.O. Box 55897                                                 Slippery Rock, PA 16057          Fairfax, VA 22030
                                                                                                                          Iota Iota/Greensboro
Jacksonville, AL 36265        Theta Sigma/Central Florida   Gorham, ME 04038              Trenton, NJ 08638               Alpha Xi Delta                 Delta Nu/IN U of PA              WASHINGTON
Zeta Xi/Auburn            Alpha Xi Delta                    MARYLAND                      Iota Nu                         Membership Vice President      Alpha Xi Delta                   Nu/U of Washington
Alpha Xi Delta            Membership Vice President         Theta Delta/Towson            Alpha Xi Delta                  Student Activities Dept.       Membership Vice President        Alpha Xi Delta
Membership Vice President 4101 Greek Park Dr.               Alpha Xi Delta                Membership Vice President       815 W. Market St.              IUP-104 Pratt Hall               Membership Vice President
Dowell Hall               Orlando, FL 32816                 Membership Vice President     400 Cedar Avenue                Greensboro, NC 27401           201 Pratt Dr.                    1616 N.E. 50th St.
Auburn, AL 36849                                            8000 York Rd., Box #4127      Office of Student Activities                                   Indiana, PA 15701                Seattle, WA 98105
                              GEORGIA                                                                                    OHIO
                                                            Towson, MD 21252              & Student Center Orgs , Box 49                                 Zeta Eta/West Chester
Theta Phi/Alabama-            Gamma Eta/Georgia Tech                                                                     Gamma/Mount Union                                                Epsilon Zeta/Eastern
                                                                                          West Long Branch, NJ 07764                                     Alpha Xi Delta
Birmingham                    Alpha Xi Delta                                                                             Alpha Xi Delta                                                   Washington
Alpha Xi Delta                Membership Vice President     Massachusetts                 NEW MEXICO                     Membership Vice President       Membership Vice President        Alpha Xi Delta
Membership Vice President     847 Techwood Dr.              Iota Xi                       Theta Omega/New Mexico         143 W. Simpson                  Sykes Student Union              Membership Vice President
1400 University Blvd.         Atlanta, GA 30313             Alpha Xi Delta                State                          Alliance, OH 44601              West Chester University          324 2nd St.
P.O. Box 26                                                 Membership Vice President     Revitalizing Spring 2009                                       West Chester, PA 19383           Cheney, WA 99004
                          Delta Xi/Georgia State            WPI                                                          Pi/Ohio
Birmingham, AL 35294                                                                      Member Services                                                Theta Alpha/Millersville Univ
                          Alpha Xi Delta                    52 North Ashland Street                                      Alpha Xi Delta                                                   WEST VIRGINIA
                          Membership Vice President                                       8702 Founders Road             Membership Vice President       Alpha Xi Delta
ARIZONA                                                     Worcester, MA 01609                                                                                                           Delta/Bethany
                          Georgia State University                                        Indianapolis, IN 46268         16 S. College St.               Membership Vice President
Theta Zeta/Embry-Riddle                                                                                                                                                                   Alpha Xi Delta
Alpha Xi Delta            33 Gilmer St. S.E.                MICHIGAN                                                      Athens, OH 45701               Millersville Univ.               Membership Vice President
                                                                                          NEW YORK
Membership Vice President Atlanta, GA 30303                 Phi/Albion College-CPO                                                                       c/o SMC Box #110                 P.O. Box 539
                                                                                          Eta/Syracuse                    Psi/Ohio State
c/o Student Activities                                      Alpha Xi Delta                                                                               Millersville, PA 17551           Bethany, WV 26032
                          Zeta Omega/West Georgia                                         Alpha Xi Delta                  Alpha Xi Delta
3700 Willow Creek Rd.                                       Membership Vice President     Membership Vice President                                      Iota Mu/Lycoming
                          Alpha Xi Delta                                                                                  Membership Vice President                                       Iota/West Virginia
Prescott, AZ 86301                                          4680 Kellogg Center           125 Euclid Ave.                                                Alpha Xi Delta
                          Membership Vice President                                                                       76 E. 15th Ave.                                                 Alpha Xi Delta
                                                            Albion, MI 49224              Syracuse, NY 13210                                             Membership Vice President
ARKANSAS                  P.O. Box 10052 UWG                                                                              Columbus, OH 43201                                              Membership Vice President
                                                                                                                                                         700 College Pl. #334
Gamma Omega/Henderson Carrollton, GA 30118                  Gamma Zeta/Eastern            Delta Zeta/Long Island          Beta Mu/Bowling Green State                                     618 Spruce St.
                                                            Michigan                                                                                     Williamsport, PA 17701           Morgantown, WV 26505
State                     Iota Theta/Southern                                             C.W. Post                       Membership Vice President
Alpha Xi Delta                                              Alpha Xi Delta                Alpha Xi Delta
                          Polytechnic State                                                                               220 Thurstin Ave.              SOUTH CAROLINA                   Beta Sigma/West Virginia
Membership Vice President Alpha Xi Delta                    Northern Michigan U. 605 W.   Membership Vice President       Bowling Green, OH 43403        Epsilon Iota/Newberry College    Wesleyan
HSU Box 6487                                                Cross St.                     720 Northern Blvd.
                          Membership Vice President                                                                                                      Alpha Xi Delta                   Alpha Xi Delta
Arkadelphia, AR 71999                                       Ypsilanti, MI 48197           Hillwood Commons                Beta Xi/Marietta
                          Alpha Xi Delta                                                                                                                 Membership Vice President        Membership Vice President
                                                                                          Greenvale, NY 11548             Alpha Xi Delta
Zeta Iota/Lyon            1100 S. Marietta Pkwy.            Delta Delta/ Northern                                                                        Box 286                          MSC #184; WVWC
                                                                                                                          Membership Vice President
Alpha Xi Delta            Marietta, GA 30060                Michigan U.                   Delta Lambda/Rochester                                         2100 College St.                 59 College Ave.
                                                                                                                          322 Fifth St.
Membership Vice President IDAHO                             Alpha Xi Delta                Institute of Tech                                              Newberry, SC 29108               Buckhannon, WV 26201
                                                                                                                          Marietta, OH 45750
2300 Highland, L.C. Box 217 Epsilon Psi/Boise State         Membership Vice President     Alpha Xi Delta
                                                            Box 96, University Center                                     Beta Tau/Kent State            SOUTH DAKOTA                     Gamma Beta/Marshall
Batesville, AR 72501        Alpha Xi Delta                                                Membership Vice President                                      Epsilon/South Dakota             Alpha Xi Delta
                                                            Marquette, MI 49855           6200 Kimball Dr.                Alpha Xi Delta
CALIFORNIA                    Membership Vice President                                                                   Membership Vice President      Alpha Xi Delta                   Membership Vice President
                              1818 Yale Court               Delta Sigma/Ferris State      Rochester, NY 14623                                            Membership Vice President        1645 5th Avenue
Gamma Epsilon/Cal State                                                                                                   571 S. Lincoln St.
                              Boise, ID 83705               Alpha Xi Delta                Zeta Phi/Binghamton U.                                         214 N. Plum                      Huntington, WV 25703
Fresno                                                                                                                    Kent, OH 44240
                                                            Membership Vice President     Alpha Xi Delta                                                 Vermillion, SD 57069
Alpha Xi Delta                Iota Kappa/Idaho State                                                                                                                                      Epsilon Theta/West
                                                            805 Campus Dr.                Membership Vice President       Gamma Tau/Ohio Northern
Membership Vice President     Alpha Xi Delta                                                                                                             Epsilon Eta/South Dakota State   Liberty State
                                                            Rankin Center Box 23          59 Seminary Avenue              Alpha Xi Delta
5327 N. Millbrook Ave.        Membership Vice President                                                                                                  Alpha Xi Delta                   Alpha Xi Delta
                                                            Big Rapids, MI 49307          Binghamton, NY 13905            Membership Vice President
Fresno, CA 93710              Idaho State University                                                                                                     Membership Vice President        Box 5A Main Hall
                                                                                                                          125 East College Ave.
                              Campus Box 8787               Zeta Upsilon/Alma             Theta Theta/Brooklyn                                           1203 Eighth St.                  West Liberty State College
Delta Rho/Cal State                                                                                                       Ada, OH 45810
                              Pocatello, ID 83209           Alpha Xi Delta                Alpha Xi Delta                                                 Brookings, SD 57006              West Liberty, WV 26074
Northridge
                                                            Membership Vice President     Membership Vice President       Delta Pi/Defiance
Alpha Xi Delta                ILLINOIS                                                                                                                   TENNESSEE                        WISCONSIN
                                                            815 West Superior St.         3000 Ocean Pkwy Apt #23T        Alpha Xi Delta
Membership Vice President     Kappa/Illinois                                                                                                             Gamma Theta                      Beta Psi/Carroll
                                                            Alma, MI 48801                Brooklyn, NY 11223              Membership Vice President
17720 Halsted St.             Nikki Seffron                                                                                                              Alpha Xi Delta                   Alpha Xi Delta
                                                                                                                          701 N. Clinton
Northridge, CA 91325          8702 Founders Road            Theta Eta/Western Michigan    Theta Kappa/SUNY Albany                                        Membership Vice President        Membership Vice President
                                                                                                                          Defiance, OH 43512
                              Indianapolis, IN 46268        Alpha Xi Delta                Alpha Xi Delta                                                 East Tennessee State             100 N. East Ave.
Theta Beta/Sonoma State
                                                            Membership Vice President     Membership Vice President       Zeta Theta/Wright State        ETSU P.O. Box 70276              Waukesha, WI 53186
Alpha Xi Delta
                                                            1702 Fraternity Village Dr.                                   Alpha Xi Delta
Membership Vice President Beta Epsilon/Monmouth U                                         130 CC Box                                                     Johnson City, TN 37614
                                                                                                                                                                                          Delta Alpha/Wisconsin
                                                            Kalamazoo, MI 49006                                           Membership Vice President
6585 Commerce Blvd. #296 Alpha Xi Delta                                                   1400 Washington Ave.
                                                                                                                                                         Theta Pi/Christian Brothers      LaCrosse
                             Membership Vice President                                    Albany, NY 12222                Greek Affairs/Judicial Srvcs
Rohnert Park, CA 94928                                      MISSOURI                                                                                     Alpha Xi Delta                   Alpha Xi Delta
                             318 N. 9th St.                                                                               Wright State University
Theta Rho/Cal State San                                     Gamma Nu/Southeast            Alpha Beta/Cornell University   3640 Colonel GlennHwy          Membership Vice President        Membership Vice President
                             Monmouth, IL 61462             Missouri State
 Marcos                                                                                   Alpha Xi Delta                  Fairborn, OH 45324             650 E. Parkway South             1725 State Street
Alpha Xi Delta               INDIANA                        Alpha Xi Delta                Membership Vice President                                      Box # T-4                        212 Cartwright Center
                                                            Membership Vice President     115 The Knoll                   Zeta Nu/Miami                  Memphis, TN 38104                Box #126
Membership Vice President Alpha Eta/Purdue
                                                            1000 Towers Cir.; Group J     Ithaca, NY 14850                Alpha Xi Delta                                                  LaCrosse, WI 54601
P.O. Box 2643                Alpha Xi Delta
                                                            Cape Girardeau, MO 63701                                      Membership Vice President      TEXAS
San Marcos, CA 92079         Membership Vice President                                                                                                                                    Delta Tau/Wisconsin
                                                                                          NORTH CAROLINA                  377 Shriver Center             Beta Alpha/Texas
                             519 University St.             AXD Epsilon Xi/Missouri                                                                                                       Oshkosh
Iota Beta/Cal State Stanislaus                                                            Gamma Phi/East Carolina         Oxford, OH 45056               Alpha Xi Delta
                             West Lafayette, IN 47906       St.Louis                                                                                                                      Alpha Xi Delta
Alpha Xi Delta                                                                            Alpha Xi Delta                                                 Membership Vice President
                                                            Alpha Xi Delta                                                Theta Upsilon                                                   Membership Vice President
Membership Vice President Beta Pi/Indiana                                                 Membership Vice President                                      2508 Rio Grande
                                                            Membership Vice President                                     Youngstown State U                                              550 Algoma Blvd
4221 Laguna Seca Ct          Alpha Xi Delta                                               508 E. 11th St.                                                Austin, TX 78705
                                                            8142 Natural Bridge Road                                      Alpha Xi Delta                                                  Oshkosh, WI 54901
Modesto, CA 95356            Membership Vice President                                    Greenville, NC 27858
                                                            St. Louis, MO 63121                                           Membership Vice President      Delta Psi/Texas State San
                             1818 N. Jordan Ave.                                                                                                                                          Epsilon Alpha/Wisconsin
CONNECTICUT                                                                               Epsilon Gamma/Western           1 University Plaza             Marcos
                             Indiana University             NEBRASKA                                                                                                                      Eau Claire
Epsilon Nu/Hartford                                                                       Carolina                        Youngstown, OH 44555           Alpha Xi Delta
                             Bloomington, IN 47406          Rho/Nebraska Lincoln                                                                                                          Alpha Xi Delta
Alpha Xi Delta                                                                            Alpha Xi Delta                                                 Membership Vice President
                                                            Alpha Xi Delta                                                Theta Chi/Toledo                                                Membership Vice President
Membership Vice President IOWA                                                            Membership Vice President                                      103 Mosscliff Cir.
                                                            Membership Vice President                                     Alpha Xi Delta                                                  504 Washington Street
200 Bloomfield Ave.          Beta/Iowa Wesleyan                                           P.O. Box 878                                                   San Marcos, TX 78666
                                                            1619 R St.                                                    Membership Vice President                                       Eau Claire, WI 54701
West Hartford, CT 06117      Alpha Xi Delta                                               Cullowhee, NC 28723
                                                            Lincoln, NE 68508                                             2999 W. Bancroft               Zeta Lambda/Texas Wesleyan
                             Membership Vice President                                    Zeta Tau/North Carolina         Unit G-2                       Alpha Xi Delta                   Theta Epsilon/Marquette
DELAWARE                     607 N. Broadway                Gamma Delta/Nebraska          Asheville                       Toledo, OH 43606               Membership Vice President        Alpha Xi Delta
Theta Gamma/Delaware         Mt. Pleasant, IA 52641          Omaha                        Alpha Xi Delta                                                 1201 Wesleyan St.                Membership Vice President
Alpha Xi Delta                                                                                                            OKLAHOMA
                                                            Alpha Xi Delta                Membership Vice President                                      Fort Worth, TX 76105             919 N. 14th St.
Membership Vice President Sigma/Iowa                                                                                      Iota Delta/Central Oklahoma
                             Alpha Xi Delta                 Membership Vice President     One University Heights                                                                          Milwaukee, WI 53233
175 W. Main St.                                                                                                           Alpha Xi Delta                 Theta Lambda/Southwestern
                             Membership Vice President      6001 Dodge St., Box #19       CPO 1200
Newark, DE 19711                                                                                                          Membership Vice President      Alpha Xi Delta                   Theta Tau/Marian College
                             114 E. Fairchild               Omaha, NE 68182               Asheville, NC 28804
                                                                                                                          319 E. Thatcher                Membership Vice President        Alpha Xi Delta
FLORIDA                      Iowa City, IA 52245            NEVADA                                                                                                                        Membership Vice President
                                                                                         Zeta Chi/North Carolina          Edmond, OK 73034               1001 E. University Blvd.
Omega/Stetson                                                                                                                                                                             750 E. Division St.
                             Delta Chi/Northern Iowa        Iota Epsilon/Nevada         Wilmington                                                       SU Box 7472
Alpha Xi Delta                                                                                                            PENNSYLVANIA                                                    Box #492
                                                            Alpha Xi Delta              Alpha Xi Delta                                                   Georgetown, TX 78626
Membership Vice President Alpha Xi Delta                                                                                  Beta Lambda/Penn State                                          Fond du Lac, WI 54935
                             Membership Vice President      Membership Vice President Membership Vice President
421 N. Woodland Blvd.                                                                                                     Alpha Xi Delta                 Iota Eta/Texas El Paso
                             2410 College St.               1350 E. Flamingo Rd. Ste 13BUNCW Student Union 209                                                                            Iota Lambda/St. Norbert
Unit #8231                                                                                                                Membership Vice President      Alpha Xi Delta
                             Cedar Falls, IA 50613          Box 3433                    601 South College Road                                                                            Alpha Xi Delta
DeLand, FL 32720                                                                                                          13 Wolf Hall                   Membership Vice President
                                                            Las Vegas, NV 89119         Wilmington, NC 28407                                                                              Membership Vice President
                              KANSAS                                                                                       University Park, PA 16802     106 Union West
Theta Iota/Florida Atlantic                                                                                                                                                               Campus Center SORR
                              Alpha Kappa/Kansas State      NEW HAMPSHIRE                 Theta Nu/Elon                                                  El Paso, TX 79968
Alpha Xi Delta                                                                                                             Gamma Sigma/Thiel                                              St. Norbert College
                              Alpha Xi Delta                Tau/New Hampshire             Alpha Xi Delta
Membership Vice President                                                                                                 Alpha Xi Delta                 VIRGINIA                         100 Grant St.
                              Membership Vice President     Alpha Xi Delta                Membership Vice President
P.O. Box 27-3723                                                                                                          Membership Vice President      Delta Mu/Old Dominion            De Pere, WI 54115
                              601 Fairchild Terrace         Membership Vice President     Campus Box 7006
Boca Raton, FL 33427                                                                                                      75 College Ave.                Alpha Xi Delta
                              Manhattan, KS 66502           3 Strafford Ave.              Elon, NC 27244
Theta Xi/Florida International                                                                                            Greenville, PA 16125           Membership Vice President
                                                            Durham, NH 03824
Alpha Xi Delta                 LOUISIANA                                                                                                                 1600 W. 49th St.
Membership Vice President Delta Epsilon/New Orleans         Theta Psi/Dartmouth                                                                          Norfolk, VA 23508
University Park Campus         Alpha Xi Delta               Alpha Xi Delta
8030 SW 89th Place             Membership Vice President    Membership Vice President
Miami, FL 33173                University of New Orleans    5205 Gerry
                               49 Amelie Ave.               Hanover, NH 03755
                               Kenner, LA 70065

				
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