Active Member Contact Info, Tau Kappa Epsilon

Please enter the contact info requested in the form below that includes information on you and on how we might communicate with your parents in the future in the event of an emergency.

This is part of our overall Risk management Policy and is required by TKE Office of the Grand Council and is required of each member in the Active Chapter

PERSONAL INFO

First Name *

Last Name *

Birthday *

Month *

Day *

Year *

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High School You Graduated From

Year in School at NWMSUFreshmanSophomoreJuniorSeniorGraduatedGrad SchoolWhat year in school are you? Please check one of the options. Please mark Graduated if you have graduated but are still attending but not in Graduate School.

Major *

Most Recent Semester GPA *

Cumulative GPA *

Membership in other campus organizations

Expected Graduation Date

Semester

Year

Pledge Class

Semester

Year

Address Information

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code

Contact Information

Dorm or Maryville Street Address *Enter your dorm and room number or the address of your off campus residence. We assume your city, state and zip code is Maryville, MO 64468.

School e-mail *This is your "s-address" given to you by the University.

Personal e-mail

Cell Phone Number *

Influencer - Member that most influenced you to join TKE

FATHER'S INFORMATION

Father's Name *

Deceased? *YesNo

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code

Phone Number *

E-mail Address *

MOTHER'S INFORMATION

Mother's Name *

Deceased? *YesNo

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code

Phone Number *

E-mail Address *