EmailMe Form - ALD New Chapter Petition Form

Contact

Name of Institution *

Name *

First Last

Email *

Title *

Department/Office *

Office Phone *

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

Mailing Address *

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

Shipping Address (if different than mailing)

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

Institutional Demographics

Year the Institution Was Established *

Total Enrollment *

Current First-Year Enrollment *

Accreditation Agency *

Names of Other Honor and Recognition Societies on Campus

Brief History of the Institution *

Institution's Mission Statement *

Approval

By submitting this petition for a new chapter of Alpha Lambda Delta, it is understood there is institutional support, such as access to lists of eligible students, a dedicated chapter advisor (and replacing one that can no longer serve), clerical assistance for sending membership invitations, office space or storage for chapter records and supplies, and other tasks that go in to sustaining a successful honor society on campus. In addition to the required signature of Chapter Advisor, typical signature approvals come from the Chief Student Affairs Officer, Registrar, and President of College/University. You may substitute or add other administrative titles as necessary.

PLEASE NOTE: Listing names and information below signifies you have had conversations with the individuals in advance, they are aware of this petition, and fully support a chapter of Alpha Lambda Delta on campus.

Chapter Advisor Name *

First Last

Chapter Advisor Title *

Chapter Advisor Email *

Supporter 1: Name *

First Last

Supporter 1: Title *

Supporter 1: Email *

Supporter 2: Name

First Last

Supporter 2: Title

Supporter 2: Email

Supporter 3: Name

First Last

Supporter 3: Title

Supporter 3: Email

Additional Information