NPHC COUNCIL ROSTER OUTLINE

NPHC COUNCIL ROSTER OUTLINE

Please fill out the form as completely. All emails and phone numbers must be entered. Please put N/A where needed. ***NEW CHARTER/REACTIVATING COUNCILS: DO NOT COMPLETE THIS FORM UNTIL INSTRUCTED TO DO SO...IF YOU HAVE NOT REACHED OUT THE THE AREA COORDINATOR AND/OR ALUMNI or COLLEGIATE CHAIR PLEASE SPEAK TO THEM BEFORE COMPLETING THIS FORM***
Have you been instructed to complete this form by your Area Coordinator and/or the Alumni or Collegiate Chair*

YesNo: STOP CONTACT YOUR AREA COORDINATOR FOR FURTHER INSTRUCTIONS
Council Status*

Existing Council (Select if in existence prior to June 30, 2024)New Charter (Never held NPHC charter)Reactivating Council (less than 3 years not active, previously held charter))
Council Type*

Alumni CouncilCollegiate Council
Number (#) of Chapters in Your Council
Date Submitting*

MonthDayYear
Date
For Fiscal Year?*
Name of Person Completing Form*

First NameLast Name
Title of Person Completing Form*
Email of Person Completing Form*
Phone Number of Person Completing Form*
Select Council Preferred Time Zone*
NPHC Area*
NPHC Council Name (i.e. Inland Empire of California, No Abbreviations, include state)*
Spell out full name of council
Council Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Council Website Address*
Council List-Serve Address*
This is the link to subscribe to Mailchimp, Constant Contact, etc.
Council Passdown Email Address*
This should be a general council email (i.e. gmail.com, outlook.com, etc.) that is passed down after each term. If you do not have one please create one.
Council Correspondence Email Address*
This should be a general council email (i.e. gmail.com, outlook.com, etc.) that is passed down after each term. If you do not have one please create one.
(Collegiate Council Only) NPHC Campus-Based Advisor Name*
Person Employed by the University to advise the council
(Collegiate Council Only) NPHC Campus-Based Advisor Email*
(Collegiate Council Only) NPHC Campus-Based Advisor Phone Number*
Employed by the University to advise the council
Term Start Date*

MonthDayYear
Date
Term End Date*

MonthDayYear
Date
Next Election Date*

MonthDayYear
Date

COUNCIL OFFICER INFORMATION (ALL FIELDS MUST BE COMPLETED)*

	NAME	ORGANIZATION	CHAPTER	EMAIL	PHONE
PRESIDENT
VICE PRESIDENT
RECORDING SECRETARY
CORRESPONDING SECRETARY
TREASURER
FINANCIAL SECRETARY
PARLIAMENTARIAN
SERGEANT-AT-ARMS
CHAPLAIN
OTHER EXECUTIVE BOARD MEMBER
OTHER EXECUTIVE BOARD MEMBER
OTHER EXECUTIVE BOARD MEMBER
OTHER EXECUTIVE BOARD MEMBER
OTHER EXECUTIVE BOARD MEMBER

MEMBER CHAPTER DELEGATE/REPRESENTATIVE INFORMATION (ALL FIELDS MUST BE COMPLETED)*
MEMBER CHAPTER PRESIDENT INFORMATION (ALL FIELDS MUST BE COMPLETED)*
This form must be completed in its entirety. Please explain an N/As
Should be Empty: