Please fill out the form below to provide us as much information as possible about the young man you are recommending.

YOUR INFORMATION:

What is your full name?

E-mail address?

Street address?

City?

State?          Zip Code?
       
Phone Number?

Lambda Chi Alumnus
Zeta Number (alumni only):

HIS INFORMATION:

What is his full name?

E-mail address?

Street address?

City?

State?          Zip Code?
       
Phone Number?

When will he start attending?
Currently Already Attending
Summer 2005
Fall 2005
Spring 2006
Summer 2006
Fall 2006
Unknown

What is his current classification?
High School Junior
High School Senior
Freshman
Sophomore
Junior
Senior
Unknown

What high school, community college, or university does he currently attend?

Any additional comments: