Prospective Members Form	Back to Home

Name: Campus Address: Campus Phone: Home Address: City: State: Zip: Home Phone: Email:	Father: Mother: High School: HS Ag Instructor Intended Major: Year in School: ACT/SAT Score: GPA: HS Class Rank/Size:
Friends or Relatives in AGR (Actives or Alumni)
Agricultural Background
High School/College Activities (indicate if leadership position held)
Awards and Honors
Future/Career Goals (if known)