2021 UM Panhellenic Council COB Interest Form (For current UM Students Only)

First Name:
Last Name:
Email Address (@go.olemiss.edu):
Phone Number:
Residence Hall & Room Number/Off-Campus Address:
Permanent Home Address:
Permanent Home Address Line 2:
City:
State/Province:
Zip Code:
Hometown:
High School Name:
Year of HS Graduation: 
High School GPA:
Student ID Number:
Major:
College Credit Hours EARNED:
GPA (Cumulative):
Organizations and Groups:
Leadership Experience:
Service Experience:
Scholarship:
Relative Name:
Which Organization?
Any additional information you would like to include: