Potential Member Recommendation To be completed by members of Alpha Delta Pi only

Instructions for using this form: For chapter addresses and recruitment dates, • This form must be endorsed by either an individual or an Alumnae please check the Alpha Delta Pi website at Association but need not receive the endorsement of both. www.alphadeltapi.org. Click on the MyADPi tab • Collegiate members may only submit Potential Member then on Alumnae. The information will be under Recommendations for women attending Potential Member Recommendation and Legacy universities other than their own. Forms. • Attach a photo and résumé with this form, if available. • A personal letter may also be attached, if desired. • Mail this form directly to the chapter. Do not send to Executive Office. • If submitting this profile for a Legacy, a Legacy Introduction Form must also be completed and mailed to the chapter.

Potential Member Information Name (Last, First, Middle, Preferred) Home Address (Street, City, State, ZIP) ______

High School Attended Year Graduated ______

Previous College/University Attended Upcoming Year in School: ______ Freshman

Sophomore High School or College GPA (most recent) ACT Score SAT Score ______Junior Senior Family Information

Father’s Name Fraternal Affiliation/College ______

Mother’s Name Sorority Affiliation/College ______

Additional Alpha Delta Pi Relatives:

Mother (full name, maiden name, college) ______ Sister (full name, maiden name, college) ______ Grandmother (full name, maiden name, college) ______ Great Grandmother (full name, maiden name, college) ______ Great-Great Grandmother (full name, maiden name, college) ______ Stepmother (full name, maiden name, college) ______ Other (relation, full name, maiden name, college) ______ Other sorority influences ______

Potential Member Attitude

Friendly Reserved Other Enthusiastic Positive Poised Loyal

Scholarship Information

Honors Student ______ Scholarships Received ______ Academic Awards______ Field of Study (if known) ______

Attributes Leadership Positions Held ______

Extracurricular Activities ______

Community Service ______

Additional Comments ______

Endorsement

Recommendation:

I strongly recommend this woman based on my personal knowledge and acquaintance of the PNM for ______years. I recommend this woman based on information obtained from a reliable source, but without personal knowledge or acquaintance. I recommend this woman based on information received via a local or area Panhellenic (either by event or by request) I do not recommend this woman for membership in Alpha Delta Pi

Name Chapter ______

Home Address (Street, City, State, ZIP) E-mail Address ______

I serve Alpha Delta Pi as a(n):

Alumna (List Advisor, Int’l Officer, Alumnae Assn, House Corp position) Paid ReMember Dues? (Check if yes) Collegian Supported the Alpha Delta Pi Foundation? (Check if yes)