Application of Interest


Email Address:
Your Full Name (First and Last)
City and State
Your Frequently Checked Email Address (ex : you@aol.com)
Cellular Telephone Number
Secondary Number to Contact You
Facebook URL or Name
When is the best time to contact you?
What is the nature of your inquiry?
Race
Are you a registered voter?
What is your sexual orientation?
Your age range?
How did you learn about about Kappa Xi Omega?
List your community involvement.
Please attach a recent photo of yourself

.