EmailMe Form - DIVINE NINE ALLIANCE (DNA) MEMBERSHIP APPLICATION

Date Time *

MM / DD / YYYY

Full Name *

First Last

Student ID (A0#) *

School Email *

Secondary Email *

Shipping Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone

### - ### - ####

Walden Program of Study (Example: PhD Criminal Justice) *

Graduation Date (Month, Year) *

Divine Nine Affiliation *

Year Initiated *

Personal statement regarding interest in DNA: What interests you about joining DNA? What would you like to accomplish as a member of DNA? Would you be interested in a leadership role within the alliance? (Please do not exceed 150 words.) *

Membership Classification

There are three membership options:

General members. General members are to attend monthly and special meetings.
Dues - $40.00 annually

Sustainer members. Sustainer members are strongly encouraged to attend monthly and special meetings.
Dues - $50.00 annually

Life members. Life members are encouraged to attend monthly and special meetings.*For faculty, staff, and alumni only.
Dues - $100 annually

Please indicate which membership you are interested in *

General Member - $40 annually (non-refundable)

Sustainer Member - $50 annually (non-refundable)

Lifetime Member *For faculty, staff, and alumni only - $100 lifetime (non-refundable)

To verify Divine Nine membership, please provide a scanned copy of your Fraternity/Sorority membership card or certificate of initiation. *

Anti - Hazing Training Acknowledgement

Walden has zero tolerance for Hazing. Hazing is defined as any action taken or situation created through coercion or otherwise which, regardless of intent or consent of the participants, may reasonably produce substantial risk of causing bodily harm or danger, mental or physical discomfort, embarrassment, harassment, fright, humiliation or ridicule, or otherwise compromises the dignity of an individual; compels an individual to participate in an activity that is unlawful and/or contrary to University rules, policies and regulations; will unreasonably or unusually impair an individual’s academic efforts, and occurs on or off campus between two or more people who are affiliated with the institution including at non-sanctioned events.

Walden University will provide students with an education program on hazing which will be offered online during new student orientation session and as modules that can be taken on -demand prior to Residencies and before joining a new student organization. Organizations are prohibited from accepting or initiating students who have not attended the program.
All staff and volunteers who coach an organization recognized by and operating under the sanction of Walden University and have direct contact with students must have mandatory training on hazing, including awareness, prevention and the institution’s policy.

Copy and Paste Training Link: https://bit.ly/Anti-HazingTraining *

I will complete the Anti-Hazing Training and understand that my application to join this student organization will not be approved until after I complete the training.

** If accepted into DNA, I agree to pay the membership fee in which I have chosen. *

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Typed Signature *