Email
First name
Last name
Date of Birth
Current City
State
Phone Number
Best Time to Contact You:
Ethnicity
How did you learn about Kappa Psi Kappa Fraternity, Inc. If referred by a member, please give the member’s name in the Other box:
Event
Flyer
Brochure
Social Media (Facebook, Instagram, etc)
Member
Other
Other
Currently Involved in Community Service?
YES
NO
Check ALL that apply:
Employed
Military
Student
Unemployed
Other
Submit
Membership Interest Application