Theta Tau
REQUEST FOR ALUMNUS STATUS AS A 4-YEAR STUDENT MEMBER
Bylaws, Chapter II, Part B, Section 11. An undergraduate member who has been a student member of the Fraternity for at least 4
years may elect to assume alumnus membership in this Fraternity if his account is paid in full, by submitting application request and
fee to the Executive Director in the manner prescribed by the Executive Council. Such a status change is only effective once approved
by the Executive Director, and once approved, such a member shall have all the rights of alumnus membership.
A. I request transfer to alumnus status while an undergraduate for the following reasons:
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I have been a member of the Fraternity for at least 4 years.
I am a member in good standing.
My account is paid in full and I have no debt with the Chapter or House Corporation.
Application fee of $75 plus amount shown in item #2 below. Check is attached or charge to:
check enclosed 
Total Payment $
charge
Acct.No. |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
B.
VISA 
MasterCard 
Exp. Date |___|___| Month/Year
Applicant’s Signature
Date
C.
Full Name
Chapter
Roll Number
Initiation Date
Preferred Mailing Address
City
State
Zip Code+4
Expected Graduation Date
Telephone Number (w/area code)
D.
E.
Email Address
THIS SECTION TO BE COMPLETED BY CHAPTER OFFICERS
1. Number of student members currently in chapter:
2. This member has $
of Fraternity debt to Chapter and House Corporation (enter zero if none).
3. Signed:
Regent
Scribe
WHEN FULLY COMPLETED, MAIL OR FAX TO THETA TAU CENTRAL OFFICE.
In view of the information presented above, I approve this member's request.
DATE:
(4/2001)
Signed:
, Executive Director