Chapter Chartering Inquiry Form

Use this form to inquire about chartering a Phi Theta Kappa chapter at your college.

Required answers are marked with an asterisk.

Salutation:

* First Name:

Middle Name:

* Last Name:

* College:

* College Address (no PO boxes, please):

* City:


* State: * Zip:

* Country: Country Code:

Mailing Address (if different from college address; no PO boxes, please):

City:


State: Zip:

Country: Country Code:

* Phone Number with Area Code (include any extensions):

Fax Number with Area Code (include any extensions):

* E-mail Address:

* College Website:

* Which option best describes you?

Administrator
If so, please disclose position:

Faculty Member
If so, please disclose position:

Staff Member
If so, please disclose position:

Student

* Which of the following best describes your school's accreditation?

Which of the following do you offer?
Check all that apply.

Associate of Applied Science Degree

Associate of Arts Degree

Associate of Science Degree

Certificate - Canadian Degree

Diploma - Canadian Degree

University Transfer - Canadian Degree

None of these

* When would you like to charter?

* How did you learn about Phi Theta Kappa?

Another chapter/college, name:

Faculty/friend contact, name:

Website, address:

Internet search, website address:

Publications, name:

College President, name:

College administration, name:

Personal experience - member, where:

Personal experience - advisor, where:

All-USA Academic Team mailing or All-State Academic Team Banquet

Conference, name:

Other, please explain:

If the information on this on-line form is complete and ready to be sent to Headquarters, press Submit. If you would like to clear the form and start over, or wish to complete the form at a later date, press Reset.

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