Advisor Information Update Form

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

Answers that are required to complete this form are marked with an asterisk.

 * Choose one to describe the Advisor being updated:

Classification:

 * Name of Advisor:

 * College Where Advisor:

 * Chapter Where Advisor:

 * Advisor's Area of Discipline:

 * Advisor's Mailing Address (no PO boxes, please):

 * City:


 * State:  * Zip:

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


Advisor's Fax with Area Code:

 * Advisor's E-mail Address:

 * Was the Advisor a Phi Theta Kappa member? Yes  No

Where was the Advisor inducted?

 * Did the Advisor serve as an Advisor previously? Yes  No

 * Is the Advisor a Leadership Development Program Certified Faculty Member? Yes   No

 * Does the Advisor serve as the college's Honors Program Director or Coordinator? Yes   No

 * Is the Advisor a contact Advisor? Yes   No       (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:

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

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):


 * Information Submitted By:


New Advisors reported above will receive periodic updates from Phi Theta Kappa regarding important events, deadlines, and news of interest.

Once information is submitted and processed by Headquarters, new Advisors will be listed on the New Advisors List. This list is refreshed once a month.