First Name:
Middle Name:
Last Name:
Date of Birth:
Phone:
Address:
City:
State:
Zip Code:
Email Address:
Confirmation Email Address:
Name of High School:
Grade Point Average (G.P.A.):
Name of Church:
Minister's Name:
Mother's Name:
Mother's Email Address:
Father's Name:
Father's Email Address:
Guardian's Name:
Hobbies:
Clubs:
Talents:
Ambition
Honors
Are you a member of The Kappa League? Yes No
If so, list name, school and date
Please list three references including name, address and telephone numbers. (Ministers, Teachers, or anyone other than a family member.) All candidates must list three references.
Name:
Phone Number:
THE MEMPHIS ALUMNI CHAPTER’S BEAUTILLION PRESENTATION HAS BEEN ADOPTED AS A SOCIAL PROJECT WITH ITS MAIL GOAL OF FOSTERING HIGH MORAL, ACADEMIC AND LEADERSHIP STANDARDS AS WELL AS SOCIAL DEVELOPMENT OF YOUNG MEN WHO ARE CURRENTLY ENROLLED AS JUNIORS IN HIGH SCHOOL AND ARE PROSPECTIVE GRADUATES IN THE MEMPHIS AREA.
I, THEREFORE, AFFIRM THAT I UNDERSTAND AND MEET THE ABOVE STATEMENT OF PURPOSE AND WOULD LIKE TO BE CONSIDERED AS A CANDIDATE FOR THE BEAUTILLION PRESENTATION. I FURTHER AFFIRM THAT IF I AM CHOSEN, I WILL BE ON TIME AND PRESENT FOR ALL EVENTS AND WILL ABIDE BY THE RULES AND REGULATIONS AS SET BY THE BEAUTILLION COMMITTEE. FAILURE TO DO SO OR MISREPRESENTATION OF ANY OF THE RULES AND STATEMENTS ON THIS APPLICATION WILL DISQUALIFY ME AND THEREBY CAUSE ME TO FORFEIT MY RIGHT OF PRESENTATION AND TO FORFEIT ANY FEES PAID TO MEMPHIS ALUMNI CHAPTER OF KAPPA ALPHA PSI FRATERNITY, INC. FOR THE PRESENTATION.
Note: Application must be accompanied by $50.00 application fee. Nonrefundable
PLEASE SUBMIT APPLICATION BY MAY 1, 2015