Advisor Information Update Form

Use this form to change current advisor information or to report new advisors to Headquarters.

Is this an alumni chapter?

Advisor Status

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Salutation

Advisor Name

Advisor's College

Advisor's Chapter

Area of Discipline

Mailing Address

City

State

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Zip

Phone

Fax

Email

Birth Date

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

Home Mailing Address

City

State

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ZIP

Alternate Email

Phi Theta Kappa Member?

Induction Location

Did the Advisor serve as an advisor previously?

Is the Advisor a Leadership Development Program Certified Faculty Member?

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

Is the Advisor a contact Advisor?

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

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

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

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

Position Type

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Employment Status

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Compensation Class

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Information Submitted By

Email of Submitter