Request for Courtesy Committee Support

Please complete this form to request assistance, prayer, or to inform the brothers you desire uplift.

For whom are you making this request?

For Myself

For Another Brother in Need (If you select this box, please answer each question below as if answering for the brother in need.

If you are completing for another brother, enter their name

First name

Last name

Year Initiated (If completing for another brother, enter their initiation year)

In what chapter were you initiated? (If completing for another brother, enter their initiating chapter)

Please provide any details you can share about your request so that we can effectively serve you?

Is it ok if we share your request with the Brothers of Upsilon Tau?

Yes

What is the best mobile number to reach you? (if completing for another brother, please enter their number)

What is the best email to reach you? (if completing for another brother, please enter their email)

Mid-Hudson Ques