St. Louis Guide Right Program Registration

Name *

First

Last

Applicate Birth Date *

Address Field

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

Home Phone

Cell Phone

Email Address *

Parent/Guardian(s) Information

Please complete as many fields as possible

Parent/Guardian(s) Name *

First

Last

Is the Parent/Guardian(s) Address the *

Same as Applicant Different Address

Parent/Guardian(s) Address

Address Line 1

Address Line 2

City

State

Zip Code

Parent/Guardian(s) Phone *

Email Address *

Please identify any medical concerns

List any food allergies

Emergency Contact

Please complete this section

Name *

First

Last

Relationship *

Address Field

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email Address *

Additional Applicant Questions and Requirements

All documents should be saved as PDF before uploading

If your records have been expunged pursuant to applicable law, you are not required to answer yes to the following questions. If you are unsure whether to answer yes, we strongly suggest that you answer yes and fully disclose all incidents to avoid any risk of disciplinary action or revocation of your offer of admission.

Are you currently or have you ever been charged with or subject to disciplinary action for scholastic or any other type of misconduct at any educational institution? *

No Yes

If yes, please explain.

Have you ever been charged with a violation of the law which resulted in, or if still pending could result in, probation, community service, a jail sentence, or the revocation or suspension of your driver’s license (including traffic violations which resulted in a fine of $200 or more?) *

No Yes

If yes, please explain.

School Information

School Name *

Applicant Current Grade *

Sixth Seventh Eight Freshman Junior Senior

Expected Graduation Date *

School Address

Address Line 1

Address Line 2

City

State

Zip Code

School Phone

Extracurricular, Personal and Volunteer Activities

Extracurricular Activities

List your organizations, position, description of the activity, and hours per week of involvement.

Talents and Awards

List each, a description, the level, and number of years of involvement.

Community Service Work

List the type of work, your role, and hours per week of involvement.

Colleges/Universities You Are Interested In Attending

List the type of work, your role, and hours per week of involvement.

What Are Your Career Aspirations?

Attachments and Confirmation

Must attach the requested documents in .doc, or .pdf to complete the process

Attach Your Letter - Why are you interested in Kappa League

Select File(s)

.doc, .docx, .pdf only

Attach an Copy of Your Most Report Card

Select File(s)

Attach only .jpg, .png and .pdf

Attach an Letter of Recommendation

Select File(s)

Attach only .doc, .docx and .pdf

Do you have family obligations that may keep you from participating in extracurricular activities? *

No Yes, I have to work to supplement family income. Yes, I provide primary care for family member(s). Other

If yes or other, please describe

Application Agreement

I hereby give my permission for my son to participate in the St. Louis Alumni Guide Right/ Kappa League Program. I understand that the St. Louis Alumni Chapter of Kappa Alpha Psi is not responsible for personal injuries or loss of property. I understand that my child is free to leave the program at any time. I agree to immediately update this application when any of the information changes. I certify that this information is complete and accurate. I understand that making false or fraudulent statements within this application or residency statement will result in disciplinary action, denial of admission. If admitted, I agree to abide by the policies of the Board of Directors and the rules and regulations of the Program. Should any information change prior to my entry into the Program, I will notify the Office of Guide Right. I understand that there is no application fee with this application.

Do you understand and agree to the statement above? *

Yes, I agree