GENERAL INFORMATION

Name

Parent/Guardian Names

Address

City State Zip

Phone ( )- E-Mail

Birth Date: Month Day Year

Graduation Year

Key Club Member

Boy Scouts of America Member Troop Number (if applicable)

SCHOLASTIC INFORMATION

Cumulative H.S. GPA (un-weighted, 4.0 scale) ACT/SAT

Intended Major

High School

Intended College or University

LEADERSHIP, ACTIVITIES & ACHIEVEMENT INFORMATION

On no more than three pages, address the following in outline form. Be sure to include dates and positions held (if applicable):

List honors, awards, or scholarships.
List extracurricular activities and positions held.
List community involvement.
List work experience.
Enclose two letters of recommendation

Should you have any questions, please call Greg Barra at Sigma Phi Epsilon Headquarters, (804) 353-1901, or email to bms@sigep.org.

TRANSCRIPT

Forward Official School Transcript to:

Balanced Man Scholarship
c/o Gregory P. Barra
Director of Recruitment
Sigma Phi Epsilon Fraternity Headquarters
P.O. Box 1901
Richmond, Virginia 23218

Checking this box becomes your electronic signature