New BOC Member Application Date of Application: Complete Name: Your email Primary Phone: Alternate Phone: Complete Address (Street, City, State and Zip Code) Date of Birth: Place of Birth (City and State) Educational Information: University/College Degree(s) Institution(s) Attended: Institution(s) Attended: Major of Study: Cumulative GPA: Name of the Institution: Degree Type Sought: (e.g. B.S. or M. Ed.) Major of Study: Minor (if any): Number of hours Completed: Year of expected Graduation: Career Objective: Military Background: YesNo If Yes, please explain below: Private Information: Are you currently employed? YesNo Employer: Title: Hobbies: Organizational Affiliations: (Professional, social, non-fraternal, service-oriented or Masonic) Leadership Positions: (Describe any leadership roles held/ position) Private Information Share with the BOC Executive Board Only: Do you have any health or physical limitations? YesNo If Yes, please explain below: Have you ever been convicted of a crime: YesNo If Yes, please explain below: Reference One: Complete Name: Relationship: Your email Phone Number: Complete Address (Street, City, State and Zip Code) Reference Two: Complete Name: Relationship: Your email Phone Number: Complete Address (Street, City, State and Zip Code) Statement of Intent: In one page, tell us your objective in joining the Brothers on Campus. As an active member, how can you best serve the needs of the organization? What is your personal philosophy of service to the community? Mailing Address: Brothers On Campus 2100 Southbridge Parkway Suite 600 Birmingham,Alabama 35209 Δ