KAPPA ALPHA PSI FRATERNITY, INC. MIDDLE EASTERN PROVINCE
Chapter Certification
CERTIFICATION DEADLINE SEPTEMBER 25, 2013 @ 12:00 AM Certification for the 2013-2014 Fraternity year will be conducted in one “Phase” only. This phase will be a combination of Phases I and II from the 2012-2013 certification process. It will require the submission of certain documents that will be archived and kept on file at IHQ and/or the Province. (The documents can be uploaded, see the Checklist) Submission of these documents is due on or before 12:00 AM on September 25, 2013. Failure to comply with this deadline will result in (1) a $100 late filing fee, and (2) your chapter will be deemed as failing to meet the minimum chapter qualifications. Therefore, your chapter will be put on cease and desist until you satisfy the minimum qualifications (i.e. get certified by the Province) No Exceptions! NOTE: Any Chapter that is fined for failing to meet the certification deadline is required to submit said fine contemporaneously with their certification package submission. The Province will reject any late certification packages unless it is accompanied with payment of the fine. Late Certification packages along with your $100 late filing fee can be mailed to the following address: Kappa Alpha Psi Fraternity Inc. Middle Eastern Province PO Box 97841 Raleigh, NC 27624 Full Name
Chapter
Chapter Position
I have read the forgoing registration instructions. YES Document Submission Checklist Below is a checklist of the forms that you will need to complete for certification. The forms can be found on the Province Website in the document library. Follow all instructions to the letter. Forms Chapter Certification Form Form 1 Personal Liability, Responsibility, and Compliance Form Form 2 Proof of Insurance Form 3 Proof of Donation to the Kappa Foundation Form 4A 2012-2013 Alumni Membership Roster Form 4U 2012-2013 Undergraduate Membership Roster & GPA Form 6 2013-2014 Chapter Officers Report Form 7 2013-2014 Chapter Budget Form 8 2013-2014 Calendar of Events Form 10 Proof of IRS Form 990 Form 15 Undergraduate Memorandum of Meeting Form 16 Undergraduate Statement of Collaboration Form 17 Undergraduate Institution Greek Recruitment Policy & Probate Policy CERTIFICATION FORM Date of Report
Has the chapter paid all International dues and assessments for each financial member listed on the International Headquarters’ membership roster? Has the chapter paid all Province dues and assessments for each financial member listed on the International Headquarters’ membership roster? Has the chapter paid the Grand Chapter Insurance Premium (due October 1st of each year)? Has the chapter complied with the Return of Ritual policy? Yes No
Has the chapter registered at least on delegate to the most recent Grand Chapter meeting (81st Grand Chapter Meeting – Houston, TX)? Yes No If not, give year of last Grand Chapter meeting registered and a statement as to why chapter was not registered for the 81st Grand Chapter Meeting.
Has the chapter made annual (October 1st) contributions to the Kappa Alpha Psi Foundation, Inc.? (make checks payable to Kappa Alpha Psi Foundation) Yes No Undergraduate Chapters: Please upload a copy of check or cancelled check for a minimum of $50.00. Alumni Chapters: Please upload a copy check or cancelled check for a minimum of $100.00. Amount of Contribution
Date of Contribution
Does the chapter have a post office box or official address for correspondence? Note: A home addresses is not acceptable for Undergraduate Chapters. Yes No Record P.O. Box (mailing address)
Undergraduate Chapters ONLY Does the chapter have proof of sufficient presence of a critical mass of qualified African American and other undergraduate students to sustain a chapter of at least seven men? (this information is in the Statement of Collaboration) Yes No
Undergraduate Chapters ONLY Does the chapter have a Statement of Collaboration or other documentation signed by an institutional official (e.g., Dean of Students, Greek Affairs Advisor) endorsing the presence of the chapter? (statement should be submitted as documentation) Yes No
Undergraduate Chapters ONLY Does the chapter have documentation from an institution official stating that the chapter abides by the host institution's rules and regulations? (this is in the Statement of Collaboration) Yes No
Undergraduate Chapters ONLY Does the chapter have proof of the presence of a campus Greek life advisor or other institution staff person (e.g., Director of Student Activities, NPHC advisor) responsible for advising the chapter? (this is in the Statement of Collaboration) Yes No Name, Contact Information (address/phone/fax/E-mail)
Has the chapter paid all province-level dues and assessments? (attach letter from Province Keeper of Records that chapter is in good standing with the Province) Yes No
Has the chapter registered at least one delegate to the most recent annual Province Council meeting? Yes No Give date of last registration
Has the chapter Polemarch, Vice Polemarch, Keeper of Records, Keeper of Exchequer, Membership Intake Chairman, and Chapter Advisor attended and/or is C. Rodger Wilson Leadership Conference certified? Yes No Give date of last CRWLTC attended
Undergraduate Chapters ONLY Does the chapter have an active, trained, effective, capable chapter advisor who must be financial on all levels of the Fraternity? Yes No Name
Phone
E-mail Address
Name
Phone
E-mail Address
Undergraduate Chapters ONLY Did your chapter advisor attend the recent advisor workshop? Yes No If not, give the date of the last Advisors Workshop attended and a reason for not attending the most recent workshop.
Does the chapter have a history conducive to the principles and objectives of Kappa Alpha Psi (i.e., measures such as achievement, Guide Right, and more importantly, history of abuse to the Fraternity's rules and regulations will be evaluated by the Province Polemarch)? (include statement signed by chapter Polemarch/Advisor that chapter has current by-laws) Yes No
Does the chapter have complete chapter archives containing items as specified in the Constitution & Statutes of the fraternity? Evidence from Advisor required. Yes No Who has possession of the Chapter archives?
How many Rituals does the Chapter have in its possession?
Please list all of the Ritual Serial Numbers:
Undergraduate Chapters ONLY Does the chapter have evidence that each member of the chapter has signed and returned the Personal Liability, Responsibility, and Compliance Form? (this form must be signed by every member of the chapter as well as the chapter advisor and submitted as documentation for certification.) Yes No
Does the chapter have at least one monthly chapter meeting, in accordance with the Constitution & Statutes of Kappa Alpha Psi? (for chapters that are active and functioning only) Yes No Day of Week Meeting Held
Weekly or Monthly
Place Meeting is Held
Time When Meeting is Held
Does the chapter conduct annual Guide Right and/or Social Action projects, such as Kappa League, Scholarship Programs, etc.? Yes No Summarize Guide Right Activities
Provide a breakdown of the students in Kappa League (by grade level): 5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Household make-up of Kappa Leaguers: 2 Parent Homes Single Family Homes Geographic area of Kappa League Program: Urban Rural
Does the Chapter have a Beautillion Program?
Number of participants:
Yes Total $ of scholarships awarded?
Frequency of program:
Alumni Chapters ONLY Does the chapter have adequate presence and ample support for the undergraduate chapter? Yes No Advisors Name
Undergraduate Chapter I
Advisors Phone Number
Advisors E-mail
Advisors Name
Undergraduate Chapter II
Advisors Phone Number
Advisors E-mail
Advisors Name
Undergraduate Chapter III
Advisors Phone Number
Advisors E-mail
Alumni Chapters ONLY Has the chapter provided physical, inter-active, cooperative, and (if Necessary) financial support to undergraduate chapter(s) within its jurisdiction? Yes No
Undergraduate Chapters ONLY Does the chapter have a cumulative GPA of 2.5 or better? Each member's GPA should be 2.5/4.0 or higher (include official documentation from institution indicating the end of semester grade report from the Office of Greek Life/Office of Student of Activities) Yes No Give Chapter GPA
Attachment Select File
Alumni Chapters ONLY Has the chapter completed and submitted to International Headquarters and the Province – all reports (officers reports, membership reports, tax reports, etc.)? Yes No
Alumni Chapters ONLY Has the chapter provided membership intake orientation program training, protocol discussions, and other leadership activities to members of the chapter? Yes No
Alumni Chapters ONLY Has the chapter been the subject of disciplinary action by Grand Chapter or the Province? Yes No
I certify that the information given above is correct to the best of my knowledge.
Full Name
Attachment: Chapter Certification Form Please complete, endorse, scan and attach a copy of the Chapter Certification Form. Select File
FORM 1 PERSONAL LIABILITY, RESPONSIBILITY, and COMPLIANCE FORM
Carlos D. Watson, Esq. Province Polemarch Middle Eastern Province Kappa Alpha Psi Fraternity, Inc. Dear Brother Province Polemarch Watson: We are aware that by completing this form, we are applying permission to begin the certification process. We also understand that by submitting this certification packet detailing the steps our chapter seeks approval to be a certified chapter for the fraternity year 2013-2014. We acknowledge that deviations to the certification process are prohibited and will disqualify our chapter from the certification process. Yours in the Bond, Chapter Polemarch Name
Chapter
Location
Chapter Advisor Name
Chapter Intake Chairman Name
cc:
Senior Province Vice Polemarch Junior Province Vice Polemarch U/G - AL Board Representatives Province Membership Intake Chairman
Attachment: Personal Liability, Responsibility, and Compliance Form Please complete, endorse, scan and attach a copy of the Personal Liability, Responsibility, and Compliance Form. Select File
FORM 2 PROOF OF INSURANCE Submit proof that your chapter is current on all insurance payments. Accepted forms of payment are copies of canceled checks, copies of certified checks, E-mail confirmation from IHQ or other methods approved by the Province Polemarch. In the event that you are delinquent for past insurance payments, include proof that you have paid any past due amounts. Failure to include satisfactory proof of insurance payment will prevent your chapter from being certified. No exceptions! Attachment Select File
I hereby certify that the attached copy is proof of the last payment(s) that satisfies my obligation to pay chapter insurance.
Full Name
FORM 3 PROOF OF DONATION TO THE KAPPA FOUNDATION Submit proof that your chapter made a donation to the Kappa Foundation for the current fraternity year. Accepted forms of payment are copies of canceled checks, copies of certified checks, E-mail confirmation from the Foundation or other methods approved by the Province Polemarch. No exceptions! Attachment Select File
I hereby certify that the attached is proof of my chapter's donation to the Kappa Foundation.
Full Name
FORM 4 2012-2013 MEMBERSHIP ROSTER Produce a complete copy of last year’s final membership roster. The membership roster should include the names of every Brother that paid any moneys to your Chapter, whether the Brother was fully financial on all three levels or not. If your Chapter considered the Brother a member of your Chapter then please include his name on your roster. Your Chapter’s membership roster should contain the Brothers name, membership number and E-mail. It is suggested that your membership roster be put in a spreadsheet or a table. It must be typed. Below is a suggested format. Attach your membership roster to this form and submit.
SUGGESTED ALUMNI CHAPTER FORMAT Last Name First Name Membership Number Email Diggs Elder Watson 19110001
[email protected] Armstrong Byron K. 19110002
[email protected] Lee John M. 19110003
[email protected] Booton Ray 196800234
[email protected] Barnes Lindsey G. 1940000581
[email protected] Rainbow William A 1942000986
[email protected] Watson Edward 201000872
[email protected]
SUGGESTED UNDERGRADUATE CHAPTER FORMAT Last Name Diggs Armstrong Lee Booton Barnes Rainbow Watson Entertainer
First Name Elder Watson Byron K. John M. Ray Lindsey G. William A Edward Cerdric
Membership Number 19110001 19110002 19110003 196800234 1940000581 1942000986 201000872 19830000361
Email Cumulative GPA
[email protected] 4.0
[email protected] 3.9
[email protected] 3.8
[email protected] 3.7
[email protected] 3.6
[email protected] 3.5
[email protected] 2.54
[email protected] 2.2
Attachment Select File
FORM 6 2013-2014 CHAPTER OFFICERS REPORT Alumni Chapters If you submitted a copy of your Officers Report to the Province prior to June 30th, please ignore these instructions. If you did not submit a copy of your Officers Report to the Province prior to June 30th, please upload it to this form. Undergraduate Chapters Although the Deadline for Undergraduate Officers Report is October 31st, Undergraduate Chapter need to submit their officers report at the time of Phase I certification. Forms submitted after the respective deadline will result in applicable fines. Attachment: Chapter Officers Report Undergraduate Chapter should complete, endorse, scan and attach a copy of the Chapters Officer Report. Select File
The Alumni Chapters Officer Report was submitted prior to the June 30th deadline? Yes No The Undergraduate Chapters Officer Report has been attached? Yes No FORM 7 2013-2014 CHAPTER BUDGET Rational All Chapters in the Middle Eastern Province should be operating of a budget approved by the chapter membership. Chapter budgets should include projected income as well as fraternity obligations such as CRWLC, Province Council Meetings, insurance, and Grand Chapter registrations/expenses in a conclave year. The purpose of presenting a budget in the certification process is to ensure that both Alumni and Undergraduate Chapters have a viable, realistic and operable chapter budget that contemplates the necessary chapter expenses and needed revenues. (This information is not being requested to ascertain the savings or reserves in your Chapter Exchequer. Inclusion of saving and reserves is 100% voluntary) Instructions Submit a copy of your chapter budget that outlines your planned expenses and income for the fraternity year. In the event that your chapter does not have a budget template, templates can found on the internet. Also you can follow the Province Keeper Exchequer’s Budget which can be found in the “Province Report handed out at Province Council meetings. Failure to include a satisfactory chapter budget will prevent your chapter from being certified. Do not submit “busy work” but rather an actual budget. No exceptions! Attachment Select File
I hereby certify that the attached budget was approved by the membership of my chapter for the 2013-2014 budget year.
Who are the approved signers for Chapter's Exchequer?
What financial institution(s) where Exchequer accounts are held?
What is the date of last Exchequer audit?
FORM 8 2013-2014 CHAPTER CALEDAR OF EVENTS Rational All Chapters in the Middle Eastern Province should be conducting planning sessions for each fraternity year. The planning session should result in the creation of chapter programs for proposed social events, meeting locations and Guide Right activity. While MEP CC FORM 5 (Program Documentation) captures past events, this should be a calendar of events off future events. This form will be used by province officials and some of your chapter events may be published on the MEP website. Instructions Submit an itemized list, organized by month, of your Chapter’s proposed events. Include chapter Meetings, fundraisers, social events, gold outings, Kappa Week, etc. The preferred format can be found on the Middle Eastern Province website, however that format is not mandatory. Failure to include a satisfactory calendar/list of events will prevent your chapter from being certified. No exceptions! Attachment Select File
What community initiatives is the Chapter involved?
I hereby certify that the attached calendar of events or list of events was published to my chapter.
Full Name
FORM 10 PROOF OF IRS FORM 990 Every Chapter in Kappa Alpha Psi is required to submit IRS Form 990. Failure to submit a 990 may result in your Chapter losing its “509” status and being taxed as Subchapter S corporation. Therefore, please submit a copy of your chapter’s IRS Form 990. In addition, answer the questions below whether you submitted a 990. Failure to respond to this form will prevent your chapter from being certified. No exceptions! Attachment Select File
Attached is a copy of my Chapters IRS FORM 990 for the previous tax year? Yes No The Chapter submitted an IRS FORM 990 for the previous tax year? Yes No If your Chapter did not submit an IRS FORM 990 for the previous tax year, state the last year your Chapter filed.
To the best of my knowledge, my Chapter has never filed an IRS FORM 990.
I hereby certify that the above stated answers are correct to the best of my knowledge.
Full Name
FORM 15 UNDERGRADUATE MEMORANDUM OF MEETING Conduct a meeting with your University/College Dean/Director/Advisor over Greek Life and go over the items listed below. You will need to have MEP CC Forms 15, 16, and 17 with you at the meeting. Have all forms signed and returned in your Certification package. In lieu of submitting this form, your university/college Dean or Greek Life Advisor may submit the requested information on letterhead or other university generated forms. Attachment Select File
FORM 16 UNDERGRADUATE STATEMENT OF COLLABORATION Before an undergraduate chapter is re-certified, this section of the “Statement of Collaboration” must be signed by the local chapter polemarch and an institutional official (e.g., Dean of Students, Greek Affairs Coordinator) and returned to Kappa Alpha Psi Fraternity, Inc. International Headquarters, 2322-24 N. Broad Street, Philadelphia, PA 19132-4590/215-228-7181 (fax) by the local chapter. Attachment Select File
Has form been completed and submitted to International Headquarters? Yes No FORM 17 UNDERGRADUATE INSTITUTION OF GREEK RECRUITMENT POLICY & PROBATE POLICY Provide the deadline for your undergraduate institution’s Greek Recruitment/intake process to be completed, if any. Provide the deadline for your undergraduate institution’s Greek Recruitment/ intake process to be completed, if any. This form is to be signed by the University/College Dean, Director/Advisor over Greek Life AT THE TIME when you have your collaboration meeting. Attachment Select File
How many members did your chapter reclaim during the previous year?
What is/are the name(s) of the reclaimed members?
What reclamation incentives does your Chapter provide?
Are there any Kappa Scholars in your Chapter? If so, please list their name(s).
Are there any campus leaders in your Chapter? If so, please list their name(s).
Are there any elected/appointed officials in your Chapter? If so, please list their name(s).
Are there any members in the military in your Chapter? If so, please list their name(s).
PROVINCE COMMITTEE APPOINTMENTS Please list the member of your Chapter that has been assigned to each of the Province Committee's identified below. Please include phone number or E-mail address. Kappa Foundation
By-laws
Reclamation
Resolutions
Scrapbook
Balloting and Nominations
Achievement and Awards
Life Membership
Evaluations
Guide Right Director
Guide Right Student of the Year
Guide Right Kappa League
Guide Right Beautillion
Membership Orientation Intake Program
Social/Political Action
Senior Kappa Affairs
Health and Wellness
Please list the Senior Kappas currently in your Chapter (Name/Age/Chapter and Year Made):
INFORMATION TECHNOLOGY/WEB COMPLIANCE I attest on behalf of my Chapter that the "bunny rabbit" or any facsimile to any other such protected image is not posted, used, or displayed anywhere on our Chapter website, Facebook page, Twitter account, flyer, or correspondence that is anyway related to Kappa Alpha Psi Fraternity, Inc. Yes I attest on behalf of my Chapter that our webpage, Facebook page or other public imagery does not contain sexually explicit songs or images. Yes I attest that our Chapter webpage, Facebook page or other public displays does not contain pictures, images or references to alcoholic imagery or drug paraphernalia. Yes
I attest that our Chapter does not endorse or hold joint activities with any little sister organizations or affiliations such as kourts, kittens, kreams, sweethearts, k-sweets or the like. Yes
IT/Web Contact Person
Website:
Facebook Page:
Twitter Page/Handle
Listserv Address:
MEMBERSHIP INTAKE Does your Chapter plan on having membership intake this coming Fraternal Year? Yes No If so, which intake period? Fall 2013 Spring 2014 What is the local Chapter fee?
What is the total Intake fee?
