Potential New Member
Grade Release
_____________________________________
Chapter Name
GPA required: ____________
Contact Name & Number: _________________________
I hereby authorize Western Illinois University to release all grade, gpa, and disciplinary information
contained in my educational record to the Office of Student Activities, my (inter)national Greek letter
organization, Chapter President, Scholarship Chairs, Chapter Advisors, Chapter Executive Board,
Membership Board, and IFC/PHC/UGC Presidents for the purposes of checking recruitment eligibility,
awards and recognition, computing chapter academic averages, needs assessment, etc. This authorization
shall remain effective so long as I am a member of my Greek letter organization at Western Illinois
University.
New Member Name
(Print)
New Member
Signature
WIU ID Number
(Print)
DATE