Award Request
If requesting the Silver, Golden and/or Platinum Certificates, you can list the brothers names in the comments section. The same applies if you are requesting Service Order Certificates. Otherwise, please one request form per brother.
Submitter's Info
Your Name
*
First Name
Last Name
Your Position in Kappa Psi
*
Your Email
*
example@example.com
Your Phone Number
*
-
Area Code
Phone Number
Recipient's Info
Recipient's Name
*
First Name
Last Name
Is the Recipient a Brother?
*
Yes
No
Chapter
*
School
*
Award(s) to be Bestowed
*
F. Harvey Smith: Grand Regent's Letter of Recognition
W. Bruce Phillips: Certificate of Commendation
F. Harvey Smith: Order of the Platinum Mortar Certificate
Preston W. Eldridge Jr.: Order of the Golden Mortar Certificate
Robert A Magarian: Order of the Silver Mortar Certificate
Service Order Certificate
Date to be Printed on Certificate
*
-
Month
-
Day
Year
Date
Why is this recipient deserving of the specified award(s)? - 1 paragraph
*
Suggested Length: One paragraph
Mailing Info
Where is the award going?
Date you would like the reward received
*
-
Month
-
Day
Year
Date
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Would you like to submit another entry?
*
Yes
No
Submit
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