National Staff Application Contact InformationFull Name* Name* First Middle Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email Address* Home Phone*Cell Phone*Date available to work* For which position are you applying?*Associate Director for Chapter ServicesDirector of Chapter DevelopmentAcademic Record1) College/University Attended* Degree Attained* Major(s) and Minor(s)* Dates of Attendance* GPA* 2) College/University Attended Degree Attained Major(s) and Minor(s) Dates of Attendance GPA 3) College/University Attended Degree Attained Major(s) and Minor(s) Dates of Attendance GPA Fraternity RecordInitiation Chapter* Initiation Year* Other chapter affiliation (when/where) Offices Held & YearNational Programs Attended and YearExtracurricular Activities & InterestsOn campus honors, awards, clubs.Community organizations or involvement.Hobbies or special interests.General QuestionsAre you willing to relocate to Lexington, VA?* Yes No Ever been convicted of driving while impaired?* Yes No If so, please explain with date and location.Received a moving violation in past 5 years?* Yes No If so, please list with date and location.Do you have any visible tattoos or piercings?* No Yes You may attach a resume.Max. file size: 50 MB.You may attach a cover letter or personal statement.Max. file size: 50 MB.Send a copy of my application to me upon submission? Yes No Email to send copy to PhoneThis field is for validation purposes and should be left unchanged.
