Membership Termination Form

This term will be used by any Fraternity/Sorority members who wish to terminate their membership from their affiliated organization.

First Name*
Last Name*
T-Number (T00123456)*
I am a:*
Chapter*
Reason for Termination*
Consent*
I hereby wish to terminate my membership from my affiliated chapter at UA Little Rock.
Email
This field is for validation purposes and should be left unchanged.

Undergraduate