Middle Western Province Forms
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| Chapter Certification Form | This must be completed annually by undergraduate and alumni chapters. Failure to submit this form to the Province Polemarch will cause the chapter to be uncertified and ineligible to operate in the name of the fraternity. The deadline for submission of this form is customarily October 1st. |
| Statement of Collaboration | This is the Statement of Collaboration: Kappa Alpha Psi Fraternity & American Colleges And Universities which is a required attachment for the Chapter Certification Form listed above. The deadline for submission of this document coincides with the Chapter Certification Form. |
| Personal Compliance Form | This Personal Liability, Responsibility, And Compliance Form is a required attachment for the Chapter Certification Form listed above. This form must be signed by every member of the undergraduate chapter as well as the Chapter Advisor and submitted as documentation for certification in accordance with the Chapter Certification Form. The deadline for submission of this document coincides with the Chapter Certification Form. |
| Undergraduate/Alumni Agreement | Certification of an undergraduate chapter requires support from an alumni chapter. Because this is a cooperative endeavor, this Cooperation Agreement must be completed and signed by the officers of both chapters. Failure to submit this document to the Province Polemarch will prevent the undergraduate chapter from being certified. |
| Informational Sign-In Sheet | Every student who attends an Informational Meeting in the Middle Western Province should CLEARLY PRINT their full name, address, and telephone number, as well as their parents' full name, address, and telephone number on this "Sign-In Sheet." Print the form, make multiple copies for use at the meeting, then fax the completed forms to our Province Headquarters within 24 hours following the Informational Meeting. The fax number is 405-524-5601. |
| Membership Application - Form 50 | Membership in Kappa Alpha Psi begins with the Membership Intake and Orientation Program. Applicants must attend an Informational Meeting sponsored by the local chapter of the fraternity, then complete this Application For Membership (Form 50), which also requires five (5) letters of recommendation, and a current transcript (undergraduate) or proof of an undergraduate degree (alumni). The completed documentation must be submitted to the local chapter for the applicant to be considered for membership. |
| Membership Application - Form 50 - LAST PAGE | The single most often overlooked item by chapters is this last page of the Form 50 application. On this page, chapters must certify the result of the secret ballot vote and the results of the objective point rating system which must be submitted with the other application documents. Signatures of the Chapter Polemarch and Chapter Keeper of Records must be affixed. In the case of undergraduate chapters, the Chapter Advisor must also sign this page. |
| Form 60 - Page 1 Form 60 - Page 2 | This is the Undergraduate Chapter Request to Initiate. Undergraduate chapters that are certified and eligible to initiate new members must submit BOTH PAGES of the Form 60 to the Province Polemarch. The deadline for submission of this documentation is customarily at least three weeks prior to the next scheduled Cluster Initiation. These forms are now also available in PDF format: Form 60 - Page 1 in PDF OR Form 60 - Page 2 in PDF. |
| Form 61 - Page 1 Form 61 - Page 2 | This is the Alumni Chapter Request to Initiate. Alumni chapters that are certified and eligible to initiate new members must submit BOTH PAGES of the Form 61 to the Province Polemarch. The deadline for submission of this documentation is customarily at least three weeks prior to the next scheduled Cluster Initiation. |
| Undergraduate Officer Report - Form 35A | Undergraduate chapters must elect officers during their first meeting in the fall semester. This Undergraduate Officer Report must be signed by specific chapter officers and the Chapter Advisor, then submitted to the Executive Director at International Headquarters, the Province Polemarch, and the Province Keeper of Records & Exchequer. The deadline for submission of Form 35A is October 31st. |
| Alumni Officer Report Form | Alumni chapters must elect officers during their regular meeting in May. This Alumni Officer Report must be signed by specific chapter officers, then submitted to the Executive Director at International Headquarters, the Province Polemarch, and the Province Keeper of Records & Exchequer. The deadline for submission of the form is June 30th. Form is also available in PDF format. |
| Program Documentation | All chapters must complete and submit the Program Documentation form on an annual basis. The deadline for submission of this form is December 1st. |
| Parental Notification | Correspondence addressed to the parents of every student who attends an Informational Meeting in the Middle Western Province. |
| Initiation Fee Structure | A breakdown of the initiation fees for undergraduate and alumni applicants. In addition to the listed fees, undergraduate chapters may charge not more than $100 for local chapter initiation fees, and alumni chapters may charge whatever they choose. Also, applicants should be prepared to pay the expenses of transportation, lodging and food for travel to the Cluster Initiation. |
| Insurance Form/Checklist | Every chapter must pay its portion of the Grand Chapter's umbrella insurance policy. The annual fee is $600 for alumni chapters and $400 for undergraduate chapters. Before a chapter holds any event in the name of the fraternity, the chapter must complete this form and submit it to International Headquarters (IHQ) with a copy to the Middle Western Province Headquarters (PHQ). It may be faxed to IHQ at 215-228-7181, and to PHQ at 405-524-5601. |
| Nominating Committee Application | The 2008 application for province offices, including cover letter from the committee chairman, Brother William F. Gaffney. The deadline for submission of this form is 15 days prior to the opening session of the 2008 Province Council. |
| Award Applications | Applications, guidelines, and petitions for Middle Western Province Awards. Deadline for submission is four weeks prior to the start of the 2008 Province Council |
| 86th Province Council Ad Contract | Advertise in the 86th Middle Western Province Council souvenir brochure, hosted by the Omaha Alumni Chapter. Submission deadline is March 1, 2008. |
| Travel Expense Report | Use this form to submit requests to the province to be reimbursed for travel expenses. Any such travel must have prior approval by the Province Polemarch. |
