Active Status Confirmation Collegiate Chapter

Chapter President Send Original To:

Phi Upsilon Omicron, Inc.
P.O. Box 329
Fairmont, WV 26555

Provide Copy To: Region Councilor, Advisor and Chapter File

DIRECTIONS: Please submit the following information each school year BEFORE you place a supply order by October 15 (whichever is first). TYPE EACH HEADING AND SUB-HEADING, THEN THE REQUESTED INFORMATION. Your chapter will be considered active and functioning when this information arrives at the National Office.

Active Status Confirmation:

Region Name

District Number

Family & Consumer Sciences Unit (Not sub-units unless you operate with ONLY separate units, then list each)

Institution e.g., University/College

Address Room/Building/Street/City/State/Zip

Phone Number Include area code

Fax Number Include area code

E-mail Address

Unit Administrator Full Name, Titles (e.g., Ph.D., Dean)

Officers:

Provide the Residence Address Street/City/State/Zip, Phone and Fax Number and Email Address for each of the following:

President:	Vice President:	Treasurer:

Secretary:		Publicity Chair :

Term of Office (these officers will serve from month/year to month/year)

Advisors:

Provide name, title, Residence Address, Phone and Fax Number, and E-Mail Address for each of the following:

Chapter Advisors:

Financial Advisor:

Professional Program Advisor:

Chapter Membership:

Number of Undergraduate Students:

Number of Graduate Students:

Total:

Member Initiation date(s) for this school year:

Alumni Chapter President: (Address, Phone Number (including area code), E-Mail Address)

PRINT FORM BEFORE SUBMITTING

Active Status Confirmation Collegiate Chapter

Active Status Confirmation Collegiate Chapter

Phi Upsilon Omicron, a National Honor Society in Family and Consumer Sciences, has over 88,000 members.

Phi Upsilon Omicron is a member of the Association of College Honor Societies.

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