NOTE: This form should only be used in an emergency situation. Contact the PKD office for an official form (Advanced Standing form = pink card). Class:                              Orders:                                                          Degrees: Active ________               Active Undergraduate ________              Degree of Special Distinction ________ Inactive ________             Instruction ________                                Degree of Highest Distinction ________ Honorary ________          Active Alumni ________ Please check the appropriate line. SCHOLASTIC CERTIFICATION FOR THOSE SEEKING THE DEGREE: HIGHEST DISTINCTION (This selection must be completed to secure the degree of “highest distinction.”  Do NOT use this section if you are not seeking that highest degree.) Statement from College/University Registrar: I certify that applicant whose name appears on this form has achieved grade point average of 3.5 (based on a 4.0 standard.) SCHOOL SEAL                                                                                                           ________________________________________                                                                                                                                                             Signature of Registrar -------------------------------------------------------------------------------- PI KAPPA DELTA APPLICATION FOR ADVANCED STANDING Membership Number: ________________________     Date ________________ 20 ________                    Miss CIRCLE         Mrs. _____________________________________ Grad. Year ________________ ONE               Mr.                        Name, print or type                    Dr. COLLEGE/UNIV.:________________________________________________ ADDRESS:________________________________________ CITY:___________________________ STATE: ________ CHAPTER NAME: _________________________________ PROVINCE: ________________________ CURRENT MAILING ADDRESS               CURRENT PHONE: (____)____________ STREET/RT/BOX/SCHOOL: ___________________________________________________________ CITY/STATE: _________________________________________________ ZIP: ________________ PERMANENT HOME ADDRESS:          HOME PHONE: (____)____________ STREET/RT/BOX/SCHOOL: ___________________________________________________________ CITY/STATE: _________________________________________________ ZIP: ________________ CHAPTER APPROVAL ________________________________                                         ______________________________ Chapter Pres. Signature                                                                                 Sponsor Signature -------------------------------------------------------------------------------- Contact the PKD office for an official form (Advanced Standing form = pink card). Pi Kappa Delta P O Box 38 Ripon, WI  54971 (920) 748-7533 (920) 748-9478 FAX nflpikappa@nflonline.org