Name:    

 Address: 

 City:     State:  Zip:  

 Telephone Number (Home):  (Cell):  

 Email Address:  

Academic Information

 GPA(4.0):  GPA(5.0):  ACT/SAT Score: 

 High School:  Intended Major: 

Additional requirements

Please be specific and include all applicable dates

Honors, Awards, Scholarships, and other Significant acheivements:

Extra Curricular Activities:

Community Service participation (Include the organization name and specific time commitment):

Work Experience:

By clicking the Submit button, I, The applicant, understand that submission of this application earns me consideration for the Robert Tolleson Balanced Man Scholarship of the KS Eta Chapter of Sigma Phi Epsilon. By reading this statement I acknowledge that my decision to join Sigma Phi Epsilon has no bearing on the selection of winners. Finally, clicking the submit button below signifies my commitment that the information stated above is true and correct.