AlphaNet - Candidate Sign Up

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STOP HERE & READ!!

Instructions:

1. If you are requesting the applicaiton for the first time, continue this process and follow the steps in order to get the application.

*If you have previously requested an application, you will already have an account in the system and must use your email address and password to obtain the application number. The ID# will be the same as the application number. If you need assistance with obtaining your application number please call the membership department at 800 373-3089 and ask for a membership coordinator to assist you.

2. Do not enter false information in order to get an application.

3. Please do not submit information in all CAPS or all lower case letters.

4. A full current mailing address must be included in the contact information section.

5. VERY IMPORTANT ~ The application will be emailed to you, so make sure the email address you enter below is correct and active. We strongly advise you not to use AOL, .MIL, or .EDU accounts due to virus protection policies these agencies use. The email address must also be able to hold a PDF file size of at least 1MB.

6. Please check Spam/Trash folders after submitting request for application*

7. Please write down email address and password. You will need both in order to log into AlphaNET in the future.

ENTER CANDIDATE INFORMATION BELOW

Personal Information
* - Required fields indicated by asterisk.
Title:
First Name:	*
Middle Name:
Last Name:	*
Suffix:
E-Mail Address:	*

Account Security
Please enter the password that you can use to log back into AlphaNet .
Password:	*	Confirm Password:	*

Contact Information

Line 1 :	*
Line2:
City:	*
State:	*
Zip/Postal Code:	*
Country:	*

Phone Information
Preferred	Type	Number
		*

Membership Information
Chapter:

What is your date of birth?
Format: MM/DD/YYYY

Citizenship
Are you a U.S. Citizen * Yes No
If you answered no, what country are you a citizen of?

Social Security Number
This is a secure site and the SS# is used as a unique identifier for all members and aspiring members. The number will only be visible to authorized administrators and the account owner.
What is your Social Security Number? Use NUMBER ONLY - do NOT input dashes.	*

Other Information
What is your Blazer Jacket Size To find your size pleae visit JC Penny Stafford Collection Please DO NOT guess on your size.	*
Where did you (or will you) receive your undergraduate degree? * (show entry list)
If you are in school, what year are you in?	*
What is the highest degree you have obtained	*
What is your secondary e-mail address?	*

Emergency Contact Information
Emergency Contact Name & Relation Example: Jane Adams - Mother	*
Emergency Contact Phone	*
Emergency Contact E-mail	*

Restrictions

Barred from Receiving Application
select this field if candidate has been restricted from membership for a specific length of time

From:
To:

Sponsor 1
Type in the Sponsor's membership ID (THIS INFORMATION SHOULD BE OBTAINED FROM YOUR SPONSOR), then submit by clicking go, or selecting name depending on web browser.

Recommender
Type in the Recommender's membership ID (THIS INFORMATION SHOULD BE OBTAINED FROM YOUR RECOMMENDER) then submit by clicking go, or selecting name depending on web browser.

Application Checklist

Application Status

Initiation information

Electronic Signature

Sign Here
PLEASE READ: By signing this memorandum of understanding, I certify that I have read and understand all of the foregoing. I agree to abide by the terms and conditions of Alpha Phi Alpha's Initial Membership Development Process (IMDP) as set forth by the general office. I specifically agree to participate only in sanctioned IMDP activities as outlined in the membership application. I agree NOT to participate in hazing activities of any kind or pledge lines and to immediately report any type of illegal activities. I further understand that if I in any way fail to abide by the terms and conditions of the IMDP process, that Alpha Phi Alpha Fraternity at its sole discretion may exclude me from consideration as an applicant for membership and may possibly pursue additional action in partnership with the university (undergraduate) and/or local law enforcement authorities.

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