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Theta Alpha Kappa Change of Chapter Representative Form
Please complete this form whenever your chapter has a faculty leadership transition.
Email address *
First name of the OUTGOING chapter representative *
Last name of the OUTGOING chapter representative *
Email address of the OUTGOING chapter representative (please repeat in full, even if supplied above; do not enter "same" or similar) *
First Name (and middle initial, if desired) of the NEW chapter representative *
Last Name of the NEW chapter representative *
Postal address of the NEW chapter representative *
City *
State (two-letter postal abbreviation) *
ZIP code *
Phone number of the NEW chapter representative *
Email address of the NEW chapter representative (please repeat in full, even if supplied above; do not enter "same" or similar) *
The semester (Fall or Spring) and year when the change of leadership will become (or became) effective *
Academic Institution *
TAK Chapter Number *
TAK Chapter Greek Letters (spelled out, e.g., Alpha Beta Gamma) *
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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