PKP Student Opportunity Fund Nomination

Please complete this form so we can contact and register students you would like to provide with the free, one-year membership. Please fill out this form for each student you wish to nominate. They will recieve a link asking them to submit information for membership. Contact chapters@phikappaphi.org with any questions.

NOTE: Student Opprotunity Fund positions can only go to those who have not yet joined as members. Reimbursement for dues which have already been paid are not allowed.

INSTITUTION NAME

CHAPTER NUMBER

STUDENT NAME

First NameLast Name

STUDENT EMAIL

By disclosing and submitting this information to The Honor Society of Phi Kappa Phi, you acknowledge, agree, and affirm that you have obtained the student’s permission and consent to disclose their information for purposes of the Student Opportunity Fund. You also acknowledge and agree that you are complying with the Family Educational Rights and Privacy Act (FERPA), 20 U.S.C. § 1232g; 34 C.F.R. §§ 99.1-99.67, federal and state laws and regulations, and all FERPA policies and procedures of your institution. Please do not provide any information other than ‘Directory Information’ as defined by FERPA and your institution. Please remove all students who have opted out of disclosing Directory Information in accordance with FERPA.

FERPA COMPLIANCE

CHAPTER FEES

SUBMITTER NAME

First NameLast Name

SUBMITTER EMAIL

CHAPTER OFFICER POSITION

Please type the code

STUDENT OPPORTUNITY FUND