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Theta Alpha Kappa Change of Chapter Representative Form
Please complete this form whenever your chapter has a faculty leadership transition.
* Required
Email address
*
Your email
First name of the OUTGOING chapter representative
*
Your answer
Last name of the OUTGOING chapter representative
*
Your answer
Email address of the OUTGOING chapter representative (please repeat in full, even if supplied above; do not enter "same" or similar)
*
Your answer
First Name (and middle initial, if desired) of the NEW chapter representative
*
Your answer
Last Name of the NEW chapter representative
*
Your answer
Postal address of the NEW chapter representative
*
Your answer
City
*
Your answer
State (two-letter postal abbreviation)
*
Your answer
ZIP code
*
Your answer
Phone number of the NEW chapter representative
*
Your answer
Email address of the NEW chapter representative (please repeat in full, even if supplied above; do not enter "same" or similar)
*
Your answer
The semester (Fall or Spring) and year when the change of leadership will become (or became) effective
*
Your answer
Academic Institution
*
Your answer
TAK Chapter Number
*
Your answer
TAK Chapter Greek Letters (spelled out, e.g., Alpha Beta Gamma)
*
Your answer
Thanks for completing this form. If you do not receive an email confirmation message shortly at the address you provided above, please contact us at theta_alpha_kappa_inquiries@ThetaAlphaKappa.org.
A copy of your responses will be emailed to the address you provided.
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