General Instructions

(A) Use this sheet for "yes" and "no" answers; attach sheets as needed for details.

(B) Indicate the question number to which an answer on an attached sheet pertains and for each question that asks for supporting details, please attach them.

Applicant Questions

(1) Are all entities in the district in good standing with the fraternity?................................................... [ ] Yes [ ] No

(2) Were there any organized district events?...................................[ ] Yes [ ] No

(If "yes" attach details on a separate sheet of paper: describe each evenr, what each event accomplished,

how many brothers participated. Please attach any commendations or news coverage each event received.)

(4) Did all of the entities from your district attend the last National Council Meeting?........................................ [ ] Yes [ ] No

(5) Did all of your entities attend your last District Convention?............................................... [ ] Yes [ ] No

(7) Did your district do something to promote Alpha Phi Delta that could be shared with other districts?…………………………. [ ] Yes [ ] No

(If "yes" attach details on a separate sheet of paper)

(9) What was the pledge retention rate for your district for the year (fill in percentage) ______ %

(10) Has there been an increase in dues paying brothers to the alumni clubs/associations in your district? ……………………[ ] Yes [ ] No

(11) Were any entities suspended, put on probation or closed in your district this year?……………. [ ] Yes [ ] No

(12) Give a brief description of what your district has done that makes you the most proud;

Reminders

(A) DON'T FORGET: Include support documents for any items above;

(B) DON'T FORGET: A scrapbook can be submitted and will be accepted as a secondary support document only. Make sure there are no photos that are in bad taste. A scrapbook can't be submitted singularly as a petition and no videotapes, please.

Signatures

“I do herein certify that the preceding is true and accurate to the best of my knowledge. Should I purposely misrepresent any facts in this document I realize that I will be subject to disciplinary actions by the fraternity.”

Signature: _________________________ Date: ______________

District Governor

Notes

(A) Do not send documents individually; send completed application;

(B) Applications will not be returned, they will be kept in Central Office’s files;

For Central Office Use Only (Entities Only)

Fees paid on time?..............................................................................[ ] Yes [ ] No [ ] N/A

Cooperative with Central Office?...................................................... [ ] Yes [ ] No [ ] N/A

Describe: ________________________________________________________________________________________________________________________________________________

Certification of National Council Attendance?................................... [ ] Yes [ ] No [ ] N/A

National President complaints on file?............................................... [ ] Yes [ ] No [ ] N/A

Describe: ________________________________________________________________________

________________________________________________________________________

Application Received: __/ __/__ Central Office Signature:____________________

—DEADLINE—

Return this Application by July 1st: