Chapter Representative Form
Please Verify TAK membership by completing this form. Submissions are due by 11:59 PM EST on May 22, 2021
Name of student you are verifying membership for
First Name
Last Name
Your Name
*
First Name
Last Name
Your E-mail Address
*
Your Phone Number
*
-
Area Code
Phone Number
Your School
*
We are asking you to share a brief statement, confirming this student's membership in Theta Alpha Kappa (if the student will be inducted subsequent to the deadline of the award, please indicate planned date of induction)
If you prefer you can upload a letter verifying membership instead
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