APPLICATION FOR MEMBERSHIP	
Send the following forms to the International Office two (2) weeks following the selection of new members.	
	1)	THIS COMPLETED APPLICATION (ALL THREE COPIES PBS-2)
2)	MEMBERSHIP APPROVAL FORM (PBS-3 OR PBS-4)
3)	Phi Beta Sigma Fraternity ORDER FORM (FORM PBS-1) (Revised 9/00)
4)	COMPLETED CANDIDATE EVALUATION (PBS-6)
5)	MONEY ORDER OR CERTIFIED CHECK FOR MEMBERSHIP FEE		
	
PLEASE TYPE & Answer all questions.	
Chapter Name		Region		
Name of Applicant		Date		
PERSONAL DATA	
Complete Home Address	Home Phone		
	Daytime Phone		
	Age		Date of Birth		
CITY	STATE	ZIP		
	
School Address, if applicable:		Place of Birth		
	Marital Status		
	Name of Spouse		
CITY	STATE	ZIP	Phone #		
	
Nearest Relative (Name and relation)	Phone #		

CITY	STATE	ZIP		
EDUCATION	
College(s) Professional or technical School(s)	

	
Degree(s) Sought or Completed		Total Credits Completed		Scholastic Avg.		
Career Objective or Occupation		
Year(s) of Graduation		
Extra-Curricular College or Community Interest		
	
PERSONAL AND COMMUNITY ACTIVITIES	
Hobbies		
Have you ever been pledged to or rejected by a college Fraternity?		
If yes, give name of Fraternity and reason for rejection, etc.	
	
Membership in Fraternal, Civic or Professional Organizations	
	
PERSONAL REFERENCES	
List three references with addresses; do not include relatives	
1.		
2.		
3.		
	CITY	STATE	ZIP	
	
I hereby make application for membership in the Phi Beta Sigma Fraternity, Inc. If initiated, I will abide by tits Constitution and by-Laws, support its objectives, comply with its standards of conduct, and pay the established annual dues.	
	
Signature of Applicant		Date		
E-mail				
INFORMATION TO BE FILLED IN BY CHAPTER	
Endorsed by Brother		Chapter		
	Chapter Secretary	E-mail:		
				
Endorsed by Brother		Chapter		
	Chapter President	E-mail		

THIS SECTION TO BE FILLED OUT BY REGIONAL DIRECTOR	
Approved by Regional Director		Date		
Initiation Date		E-mail		
	
THIS SECTION FOR NATIONAL OFFICE USE ONLY	
Card#		Frat. Pin Order#		Certificate #		
	
Received by Brother		Date Received 		
Approved by Executive Director		Date Approved