Reclamation Form

First name

Last name

Phone

Membership Number

Please type your Kappa Membership Number

Most recent Chapter Affiliation

Please indicate which Chapter you were most recently affiliated with

Initiation Date

Month

Day

Year

Please list the date you were initiated into Kappa Alpha Psi Fraternity, Inc.

Chapter of Initiation

Please list the Chapter that you were initiated into

Are you financially active at the National level?

Yes

Are you a member of the Southeastern Province?

Yes

Are you a returning member to the Decatur (GA) Alumni Chapter?

Yes

Any personal information that you would like to share?

Please any personal details like Employer, Self-Employment, etc.

Your answer

Any Fraternal information that you would like to share?

Leadership positions held, interest in committee support, etc.