Alpha Kappa Application Form – Fill Out and Use This PDF

Alpha Kappa Alpha Sorority, Incorporated®

Undergraduate Membership Interest 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. 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.

__________________________________			______________________________
Signature of Candidate			Date (Must sign and date)
CHAPTER INFORMATION
__________________________		_____________________________________		____________________________
Chapter of Interest		Name of College or University		City and State
PERSONAL INFORMATION
__________________________		________	_______________________	____________________________
First Name		Middle	Last Name	Email Address
_____________________________________			______________________________________		______________
Permanent Address			City and State		Zip Code
_____________________________________			______________________________________
Home Phone (include area code)			Cell Phone (include area code)
_____________________________________			______________________________________		______________
School Address			City and State		Zip Code
School Classification: (Circle One): Freshman			Sophomore Junior Senior

Name(s) Previously Used (if applicable):______________________________________________________________________

Degree(s) Previously Earned (if applicable): Type________________ Date: _____________ School: _____________________

_______________________________		_______________________________	_______________________________
In Case of Emergency Contact		Relationship	Email
_______________________________		_______________________________
Cell Phone		Home Phone
AFFIRMATION STATEMENT
1. Have you received and read the General Information for the Collegian brochure?			Yes	____		No	____

2.Have you been a member of a sorority which belongs to the National Pan-Hellenic Council or National Panhellenic

Conference?

Yes____

No

____

If you answered Yes to No. 2, please name the Sorority/Sororities and your initiation date(s).

______________________________	_______________________________
Name of Sorority	Initiation Date
______________________________	_______________________________
Name of Sorority	Initiation Date
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AFFIRMATION STATEMENT (CONTINUED)

3.Have you previously applied for membership into or pledged another Sorority that belongs to the National Pan-Hellenic

Council (includes Alpha Kappa Alpha Sorority, Inc.) or National Panhellenic Conference? Yes ____

No ____

If you answered Yes, please name the Sorority/Sororities and explain why you did not continue to pursue membership or discontinued the process with that Sorority/Sororities.

__________________________________________		___________________________________________
Name of Sorority/Date of Application		Name of Sorority/Date of Application
____________________________	_______________________________________		____________
Name of AKA Chapter	Name of College/University		Year
____________________________	_______________________________________		____________
Name of AKA Chapter	Name of College/University		Year

Explanation: ________________________________________________________________________________________

4. Have you read and do you understand Alpha Kappa Alpha Sorority’s Anti-Hazing Policy?

Yes ____

No ____

5.Have you ever participated in or been accused of hazing as it relates to Alpha Kappa Alpha Sorority, Incorporated?

Yes ____ NO ____

If you answered Yes, please explain: _____________________________________________________________________

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

If you answered Yes, please explain: _____________________________________________________________________

7.List the URL of any websites that depict you in a personal or professional manner. (i.e. Facebook, Twitter, Instagram) Write “none” if this does not apply to you. _________________________________________________________________

Please read carefully before signing the following:

BACKGROUND CHECK

As part of the membership application process, Alpha Kappa Alpha Sorority, Incorporated will conduct a background check on you. Such a process requires your permission for Alpha Kappa Alpha Sorority, Incorporated to obtain a background check from a reporting agency. You will be responsible for the cost associated with obtaining your background check. Your report may include, but not be limited to, the following information: consistent with applicable federal, state, and local laws that include obtaining information on convictions and/or pending prosecutions.

I, ___________________________, hereby authorize Alpha Kappa Alpha Sorority, Incorporated to conduct a background check

Name (Please Print Clearly)

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 in checking such information. I specifically authorize such an assessment by information services and outside entities of Alpha Kappa Alpha

Sorority, Incorporated’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, Incorporated is relying on third party information and, therefore, release Alpha Kappa Alpha Sorority, Incorporated, its affiliates, regions, chapters, and their respected agents, officers, and employees from any and all liability arising out of errors or omissions.

I understand it is the responsibility of all those applying to correct and update negative or conflicting information found on their Background Check and that there is no appeal process.

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

_______________________________________________	_____________________
Signature of Candidate**	Date**
** Must sign and date
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ANTI-HAZING POLICY

Alpha Kappa Alpha Sorority, Incorporated has a strict policy against hazing. Hazing is defined as an act or series of acts t hat may include, but are not limited to: attending unauthorized rush meetings or sessions; removing garments; eating or drinking

anything given to you as a requirement for membership in Alpha Kappa Alpha Sorority, Incorporated; being subjected to any form of verbal, physical or mental harassment, intimidation or disgrace; “underground hazing,” “financial hazing,” “pre- pledging” or “post-initiation pledging.” Alpha Kappa Alpha Sorority, Incorporated requirement is that those interested in

membership in the Sorority will support our policy against hazing, harassment and/or humiliation of any kind.

I, _________________________________, acknowledge that I have read, understand and will abide by the policy of

Name of Candidate (Please Print)

Alpha Kappa Alpha Sorority, Incorporated which forbids hazing. The candidate and parent(s) or guardian(s) for candidates under the age of twenty-one (21) further agree to indemnify and/or hold harmless Alpha Kappa Alpha Sorority, Incorporated, its affiliates, regions, chapters, and their respective agents, officers, and employees for any and all acts of hazing in which the candidate participates and which result in harm to the candidate or anyone else from this day forward in perpetuity.

_________________________________________	______________________	_____________________
Signature of Candidate**	Candidate’s Date of Birth	Date**
_________________________________________	___________________________________	_____________________
Name of Parent or Legal Guardian (Please Print)	Signature of Parent or Legal Guardian*	Date**

*If you are under 21 and married, the signature of parent or guardian is not applicable. If you are married circle YES.

**Must sign and date

AGREEMENT TO ARBITRATION

I, __________________________________ affirm that I understand and agree that any grievances and all disputes regarding

Name of Candidate (Please Print)

membership intake should generally be referred to the Regional Director for investigation and resolution. I understand and agree that all grievances and disputes of a prospective member that cannot be resolved within Alpha Kappa Alpha Sorority, Incorporated will be referred to arbitration including claims for personal injury, claims for damages to property, or disputes of any nature that cannot be resolved within Alpha Kappa Alpha Sorority, Incorporated, including those arising from the membership intake process. Any grievances and disputes regarding membership intake should be promptly referred to the Regional Director for investigation and resolution. 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 promptly report in writing to the Regional Director any infractions and violations of the rules, regulations, and guidelines relating to the intake process. The prospective member acknowledges that Alpha Kappa Alpha Sorority, Incorporated is an international organization with entities located throughout the United States of America and abroad. The prospective member recognizes by making this application for membership she agrees to the foregoing matters. The prospective member understands that this agreement has an effect on interstate commerce and is subject to the Federal Arbitration Act. The prospective candidate, her heirs and assigns, and Alpha Kappa Alpha Sorority, Incorporated, its officers, employees, agents, affiliates, chapters and members, agree that any and all disputes, conflicts, claims, and/or causes of action of any kind whatsoever, including but not limited to: contract claims, personal injury claims, bodily injury claims, injury to character claims, and property damage claims arising out of or relating in any manner whatsoever to membership of Alpha Kappa Alpha Sorority, Incorporated or to the membership intake process shall be subject to and resolved by compulsory and binding arbitration under the Federal Arbitration Act, 9 U.S.C. Section 1, et seq., and the commercial rules of the American Arbitration Association. I voluntarily sign this agreement to arbitrate after having a change to review its provisions.

__________________________________________	_______________________
Signature of Candidate**	Date**

**Must sign and date

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Undergraduate MIP Manual (December 2014)