Alpha Kappa Rho Registration Form

Alpha Kappa Alpha Sorority, Incorporated Undergraduate Membership Interest Application

(This form must be signed in the presence of a licensed notary. See page III-14 of the application)

I understand that falsification of any information on this application or attachments will eliminate me from being considered for membership into Alpha Kappa Alpha Sorority, Incorporated

CHAPTER INFORMATION

Chapter of Interest    Date

College/University    City/State    Country

PERSONAL INFORMATION

First Name    Middle Initial    Last Name

Home Phone    Work Phone    Cell Phone

Permanent Address    City/State    Zip

School Address    City/State    Zip

Email Address

List any college organization affiliation    Position held, if any/When

List any college organization affiliation    Position held, if any/When

ACADEMIC BACKGROUND

1. List any academic honors received in the last two (2) years. Please include when and where.

2. List any activities that have allowed you to serve as a role model for girls and/or women on your campus or in your community:

3. How have you helped to alleviate problems concerning our young girls and women on your campus or in today’s society?

ORGANIZATIONAL KNOWLEDGE

1. Do you have prior knowledge of Alpha Kappa Alpha Sorority, Incorporated? Yes or No

2. In your own words, describe the purpose of Alpha Kappa Alpha Sorority.

3. What talents do you possess that will ensure that Alpha Kappa Alpha Sorority will maintain its status as the premier Greek-lettered service organization for college-trained women?

4. Please list one program you would implement as an undergraduate member of Alpha Kappa Alpha Sorority. Describe the target audience and purpose.

PERSONAL ASSESSMENT

When placed in a tense situation…

1. How do you exercise good manners?

2. How do you handle conflict?

3. How do you strive to create a supportive environment?

AFFIRMATION STATEMENT

1. Have you received and read the General Information for the Collegian Brochure? Yes or No

2. Have you been a member of a sorority which belongs to the National Pan-Hellenic Council or National Panhellenic Conference? Yes or No

If yes, name the sorority/sororities and your initiation date(s).

Name of Sorority/Sororities    Date(s) of Initiation(s)

3. Have you previously applied for membership into a sorority that belongs to the National Pan-Hellenic Council or National Panhellenic Conference? Yes or No

If yes, name the sorority/sororities and explain why you did not pursue membership with that sorority/sororities.

Name of Sorority/Sororities    Date of Application(s)

4. Have you read Alpha Kappa Alpha Sorority’s Anti-Hazing Policy? Yes or No

5. Do you understand Alpha Kappa Alpha Sorority’s Anti-Hazing Policy? Yes or No

6. Have you ever participated in or been accused of hazing as it relates to Alpha Kappa Sorority, Incorporated? Yes or No

7. Have you previously applied for membership into Alpha Kappa Alpha Sorority, Incorporated? Yes or No

8. If yes to No. 7, please list the following:

Name of chapter    Name/Location of Institution    Year

Name of chapter    Name/Location of Institution    Year

9. Have you ever participated in or been accused of hazing as it relates to any organizations? Yes or No

10. Have you ever been convicted of a felony? Yes or No

If yes, please describe the circumstances.

1. List the URL of any websites that depicts you in a personal or professional manner.

BACKGROUND CHECK

Please read carefully before signing the following:

I, hereby authorize Alpha Kappa Alpha Sorority, Incorporated to conduct a background check and to investigate my qualifications as they relate to my becoming a member in the organization for which I am applying.

I understand that Alpha Kappa Alpha Sorority, Incorporated may utilize an outside firm or firms to assist it in checking such information, and I specifically authorize such an investigation by information services and outside entities of Alpha Kappa Alpha’s choice.

I agree to release and hold harmless Alpha Kappa Alpha Sorority, Incorporated from any and all liability with respect to receipt of such information and acknowledge that Alpha Kappa Alpha Sorority, Inc is relying on third party information and, therefore, release Alpha Kappa Alpha Sorority, Incorporated, its agents, officers, and employees from any and all liability arising out of errors or omissions.

I also understand that I may withhold my permission and that in such a case, no investigation will be done, and my application for membership may not be processed further.

ANTI-HAZING POLICY

Please read carefully before signing the following:

I, affirm that the information provided in this application and all submitted documentation is true and correct.

Candidate’s Date of Birth

Name of Parent or Guardian (Please Print)

AGREEMENT TO ARBITRATION

I, affirm that I understand and agree that any grievances and all disputes brought by prospective members resulting from claims for personal injury, claims for damages to property, or disputes of any nature that cannot be resolved within the Sorority, including those arising from the membership intake process, will be referred to arbitration.

The prospective member specifically agrees to follow all of the rules, regulations, and guidelines relating to the intake process. The prospective member further agrees to report in writing any infractions and violations of the rules, regulations, and guidelines relating to the intake process.

NOTE: THIS SECTION OF THE DOCUMENT MUST BE SIGNED IN THE PRESENCE OF A LICENSED NOTARY

EVIDENCE OF COMMUNITY/CAMPUS INVOLVEMENT (ECCI) FORM

INSTRUCTIONS:

Please record information below regarding your involvement in community/campus activities or programs that have occurred within the last two (2) years. All applicants must submit at least one (1) but cannot exceed three (3) ECCI forms to be considered for membership in Alpha Kappa Alpha Sorority, Incorporated.

Additional documentation should not be submitted and subsequently will not be reviewed. This form should be completed in its entirety and any information documented without signatures will not be accepted.

Title of Activity or Program    Start Date    End Date

Location of Activity/Program    # of hours completed

Goal of Activity/Program:

Population Served (check all that apply):

Youth    Adults    Seniors    College Students    Other (Please Specify)

Please describe your specific involvement:

1. How did the program positively impact the population served?

2. Did you meet the goal of the activity/program? Please explain.

3. How did your involvement in the program affect you?

By signing this form, I verify that all of the information I have provided is true and correct. I understand that at any time, Alpha Kappa Alpha Sorority, Incorporated can rescind any rights or privileges to an applicant based on the submission of false information or documents.

Name of Supervisor (Please Print)    Title

Email Address / Work Phone / State and Zip