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Sigma Pi Men of Honor Scholarship Application

First Name:
Middle Name:
Last Name:

Permanent Address
Street:
Apt #:
City:
State:
Zip Code:

Campus Address
Dorm or Street Address:
Apt #:
City:
State:
Zip:

Cell Phone #:	xxx-xxx-xxxx format
Home Phone #:	xxx-xxx-xxxx format
Email Address:	*

High School Attended:
High School G.P.A. (On 4.0 scale):
Class Rank:
Major:
Summor Orientation Date:	mm/dd/yyyy format

Honors, Activities, Awards:
Community Service:
Please write a BRIEF explanation of why you feel you are worthy of this scholarship (250-500 words is great):

The information given here is, to the best of my knowledge, truthful and accurate. And that by submitting this application I am authorizing Sigma Pi to contact me by email, phone and US mail.	*

Type the number you see.	*
	Only click once. Filing time my be slow depending upon the volume of applications.

Questions?	You can use our online Contact Us form or by using the information listed below.

	Alex Brodsky 106 N. Governor St Iowa City, IA 52245 847-922-0634 Alexander-Brodsky@uiowa.edu

	If you have any problems submitting this form you can download a Word copy. Once filled out it can be emailed to sigmapixi@sigmapiuiowa.com