OFFICE OF STUDENT ENGAGEMENT GREEK MEMBERSHIP / INTEREST FORM
OFFICE OF STUDENT ENGAGEMENT GREEK MEMBERSHIP / INTEREST FORM
Complete form and return to the Liz Artz eartz @ ltu. edu
Fraternity / Sorority Name: Member’ s Full Name: Student ID #: Member’ s Current Address: Check class standing: Freshman Sophomore Junior Senior Graduate Member’ s Permanent Address: Member’ s Current Phone Number: Initiation Date: Emergency Contact Name: Emergency Contact Address: Emergency Contact Phone Number: Relationship: List any office or position held within Chapter: Check status:
Pledge / New Member / On Line / Prospective Member Member or Affiliate
Lawrence Tech Anti-Hazing Policy
Hazing, defined as an act that endangers the mental or physical health or safety of a student, or which destroys or removes public or private property, for the purpose of initiation, admission into, affiliation with, or as a condition for continued membership in a group or organization. The express or implied consent of the victim will not be a defense. Apathy or acquiescence in the presence of hazing are not neutral acts; they are violations of this regulation.
I understand that hazing is forbidden by the policies of the University, by State law, and by each organization recognized by Lawrence Technological University. I have read the above hazing definition and promise to report any hazing activities to the Greek Life Advisor or another Dean of Students staff member.
My signature below certifies that I have read, understand, and agree to abide by this policy. My signature also authorizes my chapter President, President Designee, Chapter Advisor, as well as the necessary LTU personnel to access my grade point average in order to verify my eligibility to participate in the organization.
Signature: Date: Chapter Officer Signature: Date:
Revised 6 / 2012
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