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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. CHAPTER INFORMATION ________________________________________________________________ Chapter of Interest Today’s date ________________________________________________________________ Location of Chapter City, State Country

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

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

3. How have you helped to alleviate problems concerning our young girls and women on your campus or in today’s society? When? ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ORGANIZATIONAL KNOWLEDGE 1. Do you have prior knowledge of Alpha Kappa Alpha Sorority, Incorporated? Mark X: __________ Yes or _____________ No 2. In your own words, describe the purpose of Alpha Kappa Alpha Sorority. ________________________________________________________________ ________________________________________________________________

________________________________________________________________ List any college organization affiliation Position held, if any/When ACADEMIC BACKGROUND 1.

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

________________________________________________________________ 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? ________________________________________________________________

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ORGANIZATIONAL KNOWLEDGE CONT’D 4. Please list one program you would implement as an undergraduate member of Alpha Kappa Alpha Sorority? Describe the target audience and purpose. ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

AFFIRMATION STATEMENT CONT’D 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 you answered Yes to No. 3, please name the organization and explain why you did not pursue membership with that organization. ______________________________________________________ (Name of Sorority/Sororities) (Date of Application)

PERSONAL ASSESSMENT ______________________________________________________ When placed in a tense situation… ______________________________________________________ 1. How do you exercise good manners?________________________________ 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 you answered Yes to No. 7, please list the following:

________________________________________________________________ 2. How do 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 _____

________________________________________________________________ Name of chapter Name/Location of Institution Year ________________________________________________________________ Name of chapter Name/Location of Institution Year

9.

If you answered Yes to No. 2, please name the organization and initiation date. ________________________________________________________________ (Name of Sorority/Sororities) (Date of Initiation)

Undergraduate MIP Manual (November 2008)

Have you ever participated in or been accused of hazing as it relates to any organizations? Yes___or No _____ _________________________________________________________ _________________________________________________________

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AFFIRMATION STATEMENT CONT’D

BACKGROUND CHECK

10. Have you ever been convicted of a felony?

Please read carefully before signing the following:

Yes___ or No/No Record ______ General Disclaimer to All Applicants: Do not answer “Yes” and disclose any instances of arrests; any misdemeanor convictions; or any convictions that have been expunged, annulled, sealed, statutorily eradicated, pardoned, or dismissed upon condition of probation. Disclaimer to California Applicants: Do not answer “Yes” if the felony conviction was related to marijuana and such conviction is more than two (2) years old.

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 your consumer report from a consumer reporting agency. You will be responsible for the cost associated with obtaining your consumer report. Your consumer report, may include, but not be limited to, the following information: a credit report, consistent with applicable federal, state and local laws, that includes obtaining information on convictions and/or pending prosecutions; Department of Motor Vehicles information; civil suits and judgments within the past seven (7) years; accounts in collections within the past seven (7) years; and bankruptcies within the past ten (10) years.

Disclaimer to Connecticut Applicants: Do not answer “Yes” if the record of felony conviction was erased under Connecticut General Statutes Sections 46b146 (records related to determinations of “delinquency” or that, as a child, you were a member of a family with service needs), 54-76o (records related to a ruling that the applicant was a youthful offender), or 54-142a (records related to a finding that the applicant was not guilty for a criminal charge or a conviction for which the applicant has received an absolute pardon).

I, ________________________________, hereby authorize Alpha Kappa Alpha Candidate Name (Please Print) 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.

Disclaimer to Massachusetts Applicants: Answer “No or No Record” if you have a sealed record with the commissioner of probation with respect to any inquiry relative to prior arrests, criminal court appearances, or convictions.

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.

Disclaimer to Washington State Applicants: Do not answer “Yes” if the conviction is more than seven (7) years old. If you answered Yes to #10, please describe the circumstances. ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ 11. List the URL of any websites that depicts you in a personal or professional manner?

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. __________________________________________________

Name (Please Sign) _______________________________________________________

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Date


ANTI-HAZING POLICY

AGREEMENT TO ARBITRATION

Please read carefully before signing the following:

Candidate’s Date of Birth:____________

I, __________________________________ affirm that I understand and agree Name (Please Print Clearly) 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. Any grievances and disputes regarding membership intake should be 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 report in writing 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.

__________________________________________ Parent/Guardian Name (Please Print)

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

I, __________________________________ affirm that the information Candidate Name (Please Print) provided in this application and all submitted documentation is true and correct. I acknowledge that I have read, understand and will abide by the policy of 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 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. Anti-Hazing Policy Alpha Kappa Alpha Sorority, Incorporated has a strict policy against hazing. Hazing may include, but is 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, Incorporate; or being subjected to any form of verbal, physical or mental harassment, or intimidation. Alpha Kappa Alpha Sorority, Incorporated’s requirement is that those interested in membership in Alpha Kappa Alpha Sorority, Incorporated, will support our policy against hazing, harassment and/or humiliation of any kind.

________________________________________________________________ Candidate Name (Please Sign) Date

_______________________________________________________/_________ Parent/Guardian Name (Please Sign) Date

________________________________________________ Candidate’s Signature Date

__________________________________________________ Notary Seal Date III-14

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EVIDENCE OF COMMUNITY/CAMPUS INVOLVEMENT (ECCI) FORM 1. 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.

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_________________________________________________________ 2.

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.

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

________________________________________________________________ Title of Activity/Program Start Date End Date Goal of Activity/Program: ________________________________________________________________

How did the program positively impact the population served? ______

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3.

How did your involvement in the program affect you? _________________________________________________________

________________________________________________________________ _________________________________________________________ Population Served (check all that apply): _________________________________________________________ Youth ____ Adults____ Seniors____ College Students____ Other (Please Specify)___________________ ________________________________________________________________ Location of Activity/Program # of hours you completed Please Describe your Specific Involvement: ________________________________________________________________

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 _______________________________________/_________________________ Name of Supervisor (Please Print) (Title)

________________________________________________________________ ________________________________________________________________ ________________________________________________________________

______________________________/_____________________/____________ E-Mail Address Work Phone State and Zip ________________________________________________________________ Signature of Supervisor Date

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AKA