EmailMe Form - Chi Alpha Epsilon Advisor Information Form

Advisor Status

Length of time as chapter Advisor:

Advisor Name

Prefix First Last

Institution Name

Chapter

How many members are currently in your chapter?

Advisor Position Type

Advisor Position Title

Mailing Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Advisor Phone

### - ### - ####

Advisor Email

If applicable, please submit the name of co-advisors (please be advised, as the primary Advisor you will be our primary point of contact).

Co-Advisor
Co-Advisor Email
Co-Advisor
Co-Advsor Email

Information Submitted by:

Date Time

MM / DD / YYYY

Chi Alpha Epsilon wants to make certain we provide institutions with the best possible service. Please share your opinion as to how we can better serve chapters.