Advisor Information Update Form

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The Center for Excellence will be closed Monday, May 27 in honor of Memorial Day.

Use this form to change current Advisor information or to report new Advisors to Headquarters.

Advisor Status *

Advisor Name *

Advisor's College *

Advisor's Chapter *

Area of Discipline *

Mailing Address *

No P.O. boxes, please.

City *

State *

ZIP *

Phone *

Include area code (no extensions, please)

Fax

Email Address *

If the Advisor is resigning, does he/she want to keep in touch with Phi Theta Kappa?

Yes

If yes, please provide resigning advisor’s current home address below.

Home Mailing Address

City

State

ZIP

Alternate Email

Phi Theta Kappa Member? *

Yes

Induction Location *

Did the advisor serve as an advisor previously? *

Yes

Is the Advisor a Leadership Development Program Certified Faculty Member? *

Yes

Does the Advisor serve as the college's Honors Program Director or Coordinator? *

Yes

Is the Advisor a contact Advisor? *

Yes

Each chapter has one contact advisor responsible for primary correspondence with International Headquarters

If the Advisor is a new Advisor, please submit the date duties begin:

Month

Day

Year

If the Advisor is a resigning Advisor, please submit the date duties end:

Month

Day

Year

If the Advisor is a new Advisor, please submit name of the Advisor being replaced:

If the Advisor is a new Advisor, please submit name of co-Advisors (if applicable):

Position Type *

Faculty

Administration

Staff

Employment Status *

Full-time

Part-time

Adjunct

Compensation Class *

Release-Time

Stipend

None

Both

Information Submitted By *

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Phi Theta Kappa is recognized as the official honor society for community colleges by the American Association of Community Colleges.

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Phi Theta Kappa is recognized as the official honor society for community colleges by the American Association of Community Colleges.

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