Alumni Chapter Application Form

Alumni Chapter/Association

New Application or Re-Charter?*

Name of Alumni Chapter/Association*

Does your Alumni Chapter currently have a Federal Tax ID/EIN?*

Federal Tax ID/EIN*

Would you like the National Administrative Office to apply for Federal Tax ID/EIN for you?*

Name of member completing application*

Email of member completing application*

Please List Chapter Officers

President First Name*

President Last Name*

Vice President First Name

Vice President Last Name

Secretary First Name*

Secretary Last Name*

Treasurer First Name

Treasurer Last Name

Primary Contact for Chapter correspondence (Full Name)*

Primary Contact Email Address*

Primary Contact Phone Number

Alumni Chapter Website

Alumni Chapter Facebook Page

Upload Complete Roster including Full Name, Phone Number, Email Address, Address, Initiating Chapter and Year

Upload Roster Here*

Max. file size: 50 MB.

Number of current Forever KA participants or current Crimson & Gold Society Members*

The biennial dues for an Alumni Chapter shall be waived if a minimum of ten (10) alumni members listed on the Alumni Chapter’s Annual Report are either active participants in the Forever KA program or members of the Crimson & Gold Society. The charter shall be withdrawn if the particular Alumni Chapter does not maintain that participation.

List of current Forever KA participants or current Crimson & Gold Society Members*

New Application or Re-Charter

We, the undersigned, who are alumni members in good standing of Kappa Alpha Order, wish to acknowledge our continued interest in our Order and its activities and hereby express our desire to establish an alumni chapter in compliance with and authorized under Section 11-121 of the Kappa Alpha Laws. Therefore, we hereby petition the Knight Commander for a charter to be issued with the designation of

Name of Alumni Chapter/Association*

The name of an Alumni Chapter established under provisions in Title 11 shall not include the name of a dormant or Active Chapter, or full name of any college or university. Any Alumni Chapter which has been inactive for the period of one year or more, must petition for reactivation with a new name if they formerly included in their name that of a dormant or Active Chapter, or the full name of any college or university.

Upon the issuance of the charter, we do hereby pledge ourselves and our successors to abide by all duties and responsibilities of an alumni chapter as a unit of Kappa Alpha Order and to assist the Order and its officers in all lawful undertakings to the best of our abilities. We acknowledge the customs of the Order as our guiding principle, and we agree to support the standards set forth therein and to abide by the requirements of the Kappa Alpha Laws regarding the continuance of the alumni chapter should such charter be granted.

We met to organize this chapter on

Date of Initial Meeting*

In

City*

State

Alumni Chapter Chartering Fee: $500 which includes biennial alumni chapter dues of $300 which cover June 1, 2021, to May 31, 2023.

Email

This field is for validation purposes and should be left unchanged.