Membership Application

First Name: *

Last Name: *

Home Address: *

City: *

State: *

ZIP Code: *

On-Campus Address:

SHU Email: *

Other Email:

Major(s): *

EXTRACURRICULAR INTELLECTUAL ACTIVITIES

List any extracurricular intellectual activities you have been involved in since first enrolling at Sacred Heart University in specified section.

Books (Titles & Authors - Not to include course books):

Museums & Galleries (names & locations):

Performances (name & place, if possible):

Lectures & Talks (speaker name & title of talks):

COMMUNITY SERVICE

List any community service activities you have been involved in. These can include any type of charitable work that you do on a volunteer basis, such as tutoring or working with a social service organization or church group. For each activity, describe briefly what you do, and give the name and phone number of a contact person whom we may call to verify your involvement.

Community Service: *

DELTA EPSILON SIGMA APPLICATION

EXTRACURRICULAR INTELLECTUAL ACTIVITIES

COMMUNITY SERVICE

AcademicsCollege of Arts & SciencesAcademic DepartmentsPhilosophy, Theology & Religious StudiesClubs & OrganizationsDelta Gamma Chapter of Delta Epsilon SigmaMembership Application

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