Chapter Directory Form

Name

First Name

Last Name

Initiation Season

example: Fall/Spring

Initiation Year

example: 1915

Line Number

example: an ace would write "1"

Initiation Date

YYYY

Are you an active, due paying, member of Alpha Phi Alpha?

If ACTIVE in a GRADUATE Chapter, please write the Graduate Chapter Below

example: Epsilon Gamma Lambda

Undergraduate Degree Title

please separate by semi-colon (;) if dual/multiple degrees acquired example: BS Political Science with minor in Math ; BA English

Undergraduate School

example: Boston University

Graduate School Degree, Institution

please separate by semi-colon (;) if multiple degrees were acquired example: MA English, Harvard ; PhD English, University of Chicago

Current Profession

write the title with a comma (,) separating the place of work example: Chair of the Department of English, Fisk University if currently a student write Student, [Name of University]

Phone Number

personal phone number, preferred example: ###-###-#### IF an international phone number, please write your phone number in the appropriate format reflecting your nation. please include appropriate country code.

personal email, preferred

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Chapter Directory Form

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