Alpha Kappa Alpha, Inc.

Contact Us Regional Director Request Form Ivy Beyond The Wall Resolution Request General Contact Form

Ivy Beyond The Wall Resolution Request

Name of IBTW *

Date of Birth *

City of Birth *

State of Birth *

Year of Initiation *

Chapter Initiated *

Last Active Chapter *

Date Became IBTW *

IBTW Ceremony Date *

Location of Ceremony *

Alpha Kappa Alpha Offices Held

Alpha Kappa Alpha Committees Chaired

Other Accomplishments

Professional Background & Accomplishments

Family Background (please ensure correct spellings)

Name of Person Completing Form *

Email of Person Completing Form *

Phone of Person Completing Form *

Name of Family Contact *

Phone of Family Contact *

Cluster to Receive Notification *

* denotes required field