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) .