THETA TAU
REPORT OF ALUMNUS STATUS GRANTED GRADUATE STUDENT
I request transfer to alumnus status as a graduate student, effective on
for the following reason(s):
,
I understand that my semiannual dues obligation continues through the half year in which my
request is granted (Bylaws, Chapter II, Part B, Section 6).
Date
Signature
Full Name
Chapter
Roll Number
Initiation Date
Preferred Mailing Address
City
State
Zip Code+4
Degree(s) held and date(s) each received
Majority approval was given this request in a meeting held on
as is recorded in the minutes. This member ( is / is not ) free of Fraternity debt.
SIGNED:
Regent
Scribe
When all blanks have been completed, send this form promptly to:
Theta Tau Central Office, 1011 San Jacinto, Suite 205, Austin, TX, 78701, or
Via email central.office@thetatau.org, or fax to 512/472-4820.
(Rev. 9/08)