FSL Membership Termination Form

FSL Intro & Personal Information

Kansas State Fraternity and Sorority Life Membership Termination Form


Please read through the form and complete it in its entireity to ensure your information is collected appropriately. 

**DO NOT COMPLETE THIS FORM MORE THAN ONCE. IF YOU HAVE QUESTIONS ABOUT THE STATUS OF A PREVIOUS SUBMISSION, YOU CAN EMAIL GREEKLIFE@KSU.EDU OR GIVE US A CALL AT 785-532-5546 WITH ANY QUESTIONS.**
I am terminating my membership to a: *


First Name: *


Last Name: *


Phone Number: *
Do not include any (), -, or spaces.


Student ID #: *
This number should be nine digits and begin with an 8. Do not include any (), -, or spaces.


Kansas State eID:
eIDs are used to access university systems and becomes part of your K-State email, it’s used to enroll in classes, access K-State Online, and much more. DO NOT include @k-state.edu or @ksu.edu, just the eID before the @.


Personal Email Address: *


Did you complete the initiation process for the above organization? *


I herby acknowledge I am choosing to terminate my association with the above organization on my own accord. *


I understand, upon submission of this form, the Office of Fraternity & Sorority Life will remove my name from the above organization's roster and I will no longer have the privileges or responsibilities associated with the organization. *


I understand this notice serves as my official statement voiding the waiver of my rights granted by the Family Educational Rights and Privacy Act of 1974 which allowed the above organization access to my academic record. *
Student educational records, including: financial and no-directory information on your student account is confidential and protected by the Family Educational Rights & Privacy Act (FERPA). We cannot release certain information to another person with your authorization. 


By submitting this form, I agree all statements and information within are correct and factual. I agree the person completing this form matches the information within the form and no one completed this form on my behalf. *


Please provide a brief description of why you have chosen to terminate your membership. *


Would you be open to staff outreach discussing your reason for termination? *


Electronic Signature: *


Full, Legal Name: *


Date Bid was Accepted: *