NEW MEMBER APPLICATION

UC Santa Barbara CA Nu Chapter: Fall 2015

Instructions: Please complete this application and email it to Amy Tsang, Vice President of Recruitment, at
recruitment@ucsbphide.org by 8:00 PM on October 7, 2015. Upon receipt of your application and review of
all qualifications, you may be sent an email for an interview slot on one of the following dates: Thursday, 10/8
or Friday, 10/9. Interviews are 15 minutes in length and will take place on campus. Details of the interview will
be sent upon confirmation and will include verification of your GPA and class history via an unofficial transcript.
Please note: Bid Day is on Sunday, 10/11 and the deadline for dues is on the same day.
Personal Information
Full Name:
Permanent Address:
Local Address:
Email:
Phone:
Birth date:
T-shirt Size:

Major and Minor:

Year in School:
Cumulative GPA1:
Short Answer
Please answer the following questions:
1. Why are you interested in joining Phi Delta Epsilon?

2. Explain an instance where you have demonstrated Facta non Verba: Deeds Not Words.

3. Why did you decide to become a physician and how do you plan to use your time as an undergraduate
student to reach your goal?

4.

Phi Delta Epsilon takes pride in the inspiring qualities of its members. What personal attributes could you
contribute to the success of our organization?

5. Please list all other current leadership positions/activities and time commitments, including recurring
meeting/event times.

6. Are you a PhiDE legacy? Explain and list their names and school attended (VPR will verify with Executive
Office).

1You must provide an unofficial transcript at the interview. If this is your first quarter at UCSB, bring a copy of your most recent
transcript (high school, CC, etc.). You will be required to provide your Fall quarter transcript when available.