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Chapter Self-Assessment Summary of Results Form
* Indicates required question
Chapter Membership Club Levels
Name of Chapter
*
Your answer
College/University
*
Your answer
City/Community
*
Your answer
Street Number
*
Chapter Street Number
Your answer
Street Address
*
Chapter Street Address
Your answer
City
*
Chapter City
Your answer
State
*
Chapter State
Your answer
Zip Code
*
Chapter Zip Code
Your answer
President's Name
*
Your answer
Phone/Cell Number
*
President's Phone/Cell Number
Your answer
Email
*
President's Email Address
Your answer
Advisor's Name
*
Your answer
Phone/Cell Number
*
Advisor's Phone/Cell Number
Your answer
Email
*
Advisor's Email Address
Your answer
Chapter Level Status
*
Chapters in Marginal Status will be placed on performance review until performance is brought up to a minimum of Bronze Status
Gold Status
Silver Status
Bronze Status
Marginal Status
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