Membership Intake Request
Office of Student Activities
Greek Life Programs
This form is to be completed by any United Greek Council fraternal organization wishing to commence an
intake/orientation/new member preparation program resulting in the initiation of new members. All
information is to be completed and submitted to the Office of Student Activities a minimum of one week prior to
commencing any program. Failure to complete this form in conjunction with a new member education plan may
result in revocation of orientation/intake/new member education privileges for the following semester.
Organization: _________________________________________ Chapter: ____________________________
Undergraduate President: _____________________________________________________________________
Undergraduate Intake/Orientation Advisor: ______________________________________________________
On Campus Faculty/Staff Advisor: _____________________________________________________________
Graduate Chapter/Area Board Advisor: __________________________________________________________
e-mail: _________________________________________ Phone: ___________________________________
Anticipated Rush/Informational Date(s) (if applicable): __________________________________________
Intake/Orientation/New Member Education Beginning Date: _____________________________________
Intake/Orientation/New Member Education Completion Date: ____________________________________
Anticipated Initiation Date: _________________________________________________________________
Is the organization anticipating hosting a New Member Presentation/Coming Out Show?
Y/N
Proposed Dates: 1st Choice _______________
2nd Choice _______________
3rd Choice _______________
Any new member presentation must be cleared with the Assistant Director of Student Activities for Greek Life Programs to assist in
location and acceptable times of the event
Names of the students participating in the intake/orientation/new member education process will not be made
public unless requested by the organization. This information is for the record keeping purposes of the Office
of Student Activities and Student Center Operations.
We understand that by completing this information we are intending to conduct a new member
intake/orientation/education process during the current semester and that the information contained therein is
accurate and correct to the best of our knowledge. Furthermore we agree to the following as a condition of
membership intake:
- In addition to this form a New Member Education Plan must also be submitted to the Office of Student
Activities/Greek Life Programs that will outline this process
- Attend the Outcomes of Membership Intake training session facilitated by Greek Life Programs at the
chapter’s respective council meeting
- Comply with local, national, university, and inter/national organization policies regarding membership
intake
- Inform the Office of Student Activities/Greek Life Programs of any changes to the membership intake
schedule
- In concert with the Social Event Policy, the organization will not initiate new candidates into full
membership anytime following the Thursday preceding finals week
All students participating in an intake/orientation/new member education process must complete any required
New Member Education sessions facilitated by the Office of Student Activities. The undergraduate chapter
must make arrangements for these to take place with the Assistant Director of Student Activities for Greek Life
Programs during the process.
Undergraduate President Signature
Date
Undergraduate Intake/Orientation Advisor Signature
Date
The sponsoring graduate chapter is aware and in support of our undergraduate chapter commencing an
intake/orientation/new member education process under the direction of the graduate chapter.
Graduate Chapter Advisor
Date
Students Participating in Intake/Orientation/New Member Education Process
I do hereby authorize Western Illinois University to release to Chapter Presidents, Chapter Advisors, National Office, and
Assistant Director of Student Activities for Greek Life Programs my current and cumulative grade point average for the
purposes of determining my eligibility to associate with a fraternal organization at this time, determining my eligibility for
scholarships or to hold an elected office, verifying my student status, and to determine my chapter’s scholastic
performance. I understand that, on my request, I may obtain a copy of this information for my personal use.
By signing this form, I also verify that I read and understand the Western Illinois University Hazing Policy and our
national policy on hazing. I agree to not initiate or participate in any activities that can be considered hazing.
First Name
Last Name
WIU ID
Signature
Approved
by OSA
Student
Activities Use
Only
Names of the students participating in the intake/orientation/new member education process will not be made
public unless requested by the organization. This information is for the record keeping purposes of the Office
of Student Activities and Greek Life Programs.
Should there be students that remain in an interest group that are not being initiated, those names should be
submitted as part of an interest group roster.