2011 New England Regional Special Election Candidate Application

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1. Please provide your contact information.

Please provide your contact information.   Name:
Address:
Address 2:
City/Town:
State:	-- select state --AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming
ZIP:
E-mail Address:
Phone Number:

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2. Please provide your chapter adviser's contact information.

Please provide your chapter adviser's contact information.   Name:
College:
E-Mail Address:
Phone Number:

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3. Please provide your academic information.

Please provide your academic information.   Chapter:
College:
Inducted (MM/YYYY):
Current GPA:
Major:
Graduation (MM/YYYY):

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4. For which regional office are you running?

For which regional office are you running?   Central Vice President (MA only) Northern Vice President (ME/NH/VT only) Officer-at-Large (all states)

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5. In 250 words or less, describe what Phi Theta Kappa means to you and how you would use this meaning as a regional officer to promote Phi Theta Kappa.

In 250 words or less, describe what Phi Theta Kappa means to you and how you would use this meaning as a regional officer to promote Phi Theta Kappa.