Evidence of Community/ Campus

Involvement (ECCI) Form

Do Not Alter this Form
Name of Applicant _____________________________________________ Form Due Date______________________________
Last First MI
Home Phone _________________________________ Local Phone ___________________________________________
Address, City, State
Zip Code ________________________________________________________________________________________
E-Mail Address ______________________________________ Chapter of Interest___________________________________
Name of School ________________________________________________________________________________________
Location ________________________________________________________________________________________
INSTRUCTIONS TO APPLICANT: Please record information regarding your involvement in community and/or campus
activities or programs below. All applicants must submit at least one (1) ECCI Form to be considered for membership in Alpha
Kappa Alpha Sorority, Inc. Up to three (3) ECCI Forms may be submitted documenting your involvement in three different
activities. The signature of the director or advisor (i.e. supervisor) of the activity or program is required, attesting to your
involvement. Information documented without signatures will not be accepted. Only record the information requested, giving
details of your involvement. Do not submit additional documents. Additional documents will not enhance your standing, and will
not be reviewed. Only report community/campus involvement within the last two years immediately preceding this application.
Community involvement completed during your high school career is acceptable if it occurred within the last two years
immediately preceding this application.
_________________________________________________________ _________ ____________
Title of Activity or Program Start Date End Date

Goal of Activity or Program:

Population Served (check all that apply):

Youth ____ Adults ____ Seniors ____ College Students ____ Environment _____Other (Specify) _____________________

____________________________________________________________________________________________________________
Location of Activity or Program: Number of Hours You Were Involved:

Describe Your Specific Involvement::

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________
Alpha Kappa Alpha Sorority, Incorporated has a strict policy against hazing. Hazing may include, but is not limited to: attending
unauthorized rush meetings or sessions; removing garments; eating or drinking anything given to you as a requirement for
membership in Alpha Kappa Alpha Sorority, Incorporated; or being subjected to any form of verbal, physical, or mental
harassment or intimidation. The Sorority’s requirement is that those interested in membership in Alpha Kappa Alpha Sorority,
Incorporated will support its policy against hazing, harassment and/or humiliation of any kind.

By signing this form, I verify that all of the information I have provided, including, but not limited to, my signature, is true and correct. I
understand that, at any time, Alpha Kappa Alpha Sorority, Incorporated can rescind any rights or privileges it extends to an applicant based on
the submission of false information or documents.

_________________________________________________________________ __________________________________
Signature of Candidate Date
________________________________________________________________________ ______________________________________
Signature and Title of Director or Advisor Print Name
_____________________________________ ________ _____________________________________________________________________
Date E-Mail Address
_____________________________________________________________________________________________________________________
State and Zip Code Telephone Number

(November 2006)