KKΨ Petitioning Group Interest Form

Name Name Title First Last Suffix
Email
Phone Phone - ### - ### ####
Are you an initiated member of Kappa Kappa Psi (Active or Honorary)?
If yes, which chapter?
Your Professional Title
Employer
Location of Interest for (re)chartering a chapter

Name of School
How are you affiliated with this location?
What is your timeline for beginning an interest/petitioning group?