2026 SCP LIFE MEMBERSHIP PROGRAM APPLICATION

2026 SOUTH CENTRAL PROVINCE LIFE MEMBERSHIP PROGRAM APPLICATION

Kappa Alpha Psi Fraternity, Inc. ®
Province Life Membership Application Process
The program is open to brothers who meet the below eligibility requirements and complete the application process and payment:

(1) Financial on all three levels of the fraternity and active within the South Central Province for at least the preceding three consecutive years prior to application submission. (e.g. You must have been fully financial on all three levels since the 2022-2023 Fraternal Year, to be eligible at this time.)

(2) Complete the PDF JotForm on the provided link: https://form.jotform.com/261346277264158

Admission to the program is predicated upon first-come/first-serve basis and full criteria of eligibility requirements.

(3) At the time of submission, a one-time payment of $1,000.00 (plus $50.00 fee) is due. There is no subscription plan for the SCP Life Membership Program.

**Note: Please re-read the eligibility criteria and understand that failure to meet eligibility criteria will result in a refund of your submission minus the applicable fees.**

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Applicant's Information
Name

First NameLast Name
Email
example@example.com
Current Chapter
Membership Number (No dashes or spaces)
Enter 8 digits max.
Life Membership Number (No dashes or spaces)
Numbers only!
Address

Street Address

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Chapter Officer's Information
Polemarch's Name

First NameLast Name
Polemarch's Email
example@example.com
Polemarch's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Keeper of Record's Name

First NameLast Name
Keeper of Record's Email
example@example.com
Keeper of Record's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Applicant Signature

My signature indicates this information is correct to the best of my knowledge. You MUST actually sign the form Brothers!
Upload Your Current Membership OR Grand Chapter Life Membership Card

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2026 SCP Life Membership Payment
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2026 SOUTH CENTRAL PROVINCE LIFE MEMBERSHIP PROGRAM APPLICATION

Province Life Membership Application Process

Applicant's Information

Chapter Officer's Information

2026 Life Membership Payment*

Payment Methods

2026 Life Membership Payment