betas


Name:
	(first and last)
Oak ID:
Campus Address:
Phone:

Name: :
	(first and last)
PID Number:
Campus Address::
Phone::
Home Address:
Hometown Newspaper:
Major:
College:
G.P.A.:
Anticipated Graduation Date:
Date of Initiation into Beta Theta Pi:

Name of Reference:
Title:
Address:
Phone Number:
Relationaship to Nominee:

Offices and Positions held in Beta Theta Pi:
Peer Impact:	Describe how nominee/applicant has impacted peers as a result of his involvement in Beta Theta Pi
Leadership and Personal Growth:	Describe how the nominee/applicant has changed personally as a result of his leadership position(s)
Community Service:	Describe nominee/applicant involvement in community service activities
Other Activities:	List other clubs, activities, and organizations in which nominee/applicant has participated. Be sure to describe the nature and extent of involvement
Why this Candidate?:	Describe why you feel this candidate is deserving of this scholarship in light of the listed criteria

Campus Involvement Center
Baker University Center 355
Athens, OH 45701
Tel: (740) 593-4025 E-mail: involvement@ohio.edu