New Community College Chapter Application Form

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1 Kappa Delta Pi, International Honor Society in Education New Community College Chapter Application Form Application Checklist for New Community College Chapter: Before completing this application, contact Headquarters by calling or by ing Complete all questions on this application; all fields are required. Provide Institution catalogs or links to online catalogs describing Teacher Education program(s). Include at least two letters of support from campus administrators (e.g. University/College Dean, School of Education Dean/Chair, President, or Provost). Include $500 one-time installation fee (check, credit card, or money order). Postmark to: Kappa Delta Pi Chapter Development 3707 Woodview Trace Indianapolis, IN *Please note: Application will not be process until all items listed above are received.

2 New Chapter Application Form Kappa Delta Pi, International Honor Society in Education 1. Name of Institution _ 2. Address of Institution 3. Education Dept. Phone _ 4. Date Application Submitted 5. Primary Contact _ (Prefix) (First) (Last) Address _ (Street) (City) (State) (Zip) Title Office Phone Department Home Phone Fax 6. Chapter Counselor/Advisor (if different than contact) (Prefix) (First) (Last) Address _ (Street) (City) (State) (Zip) Title Office Phone Department Home Phone Fax 7. Associate Counselor/Advisor (Prefix) (First) (Last) Address _ (Street) (City) (State) (Zip) Title Office Phone Department Home Phone Fax 8. Please share with us a little about why you/your institution is interested in chartering a chapter of Kappa Delta Pi.

3 9. What goals would you like to achieve for the education program, current and prospective students, alumni, the faculty/staff, and the community by chartering a new chapter? 10. Below are the components and goals of the Chapter Member Engagement Model. Recognition Member Development Community Formally honor education students for high achievement. Celebrate triumphs both big and small along the way. Reward members for active participation. Provide leadership opportunities for all members. Utilize KDP resources to advocate for preservice and in-service educators. Create programs encouraging professional development and networking. Connect consistently with members by communicating through various mediums. Build and grow your chapter s presence on campus and in your community. Serve all colleagues in education through different programs and opportunities. Create a spirit of camaraderie and infuse fun into everything the chapter does. Using this model, describe the chapter s plans and ideas to build a sustainable chapter.

4 11. Institutional Characteristics A. Support Public supported Private, not church-related B. Institution Demographics Rural Urban C. Student Body (please check all that apply) Primarily residential Primarily commuter D. Highest Degree Offered in any Field Baccalaureate Masters Doctorate Private, church-related Independent, church-related Suburban Other Traditional Students Nontraditional Students Specialist Professional E. Date Institution Founded 12. Institutional Accreditation A. _ Date of initial accreditation of institution by the regional and/or national accrediting association. B. _ Date of most recent accreditation of institution by the regional and/or national accrediting association. C. Name of regional and/or national accrediting association _ D. Teacher Education program currently accredited by: NCATE State Agency Other 13. Enrollment Numbers Date Date Date Total Institution Enrollment (as of most recent fall semester, quarter, or term including full-and part-time students) Total Teacher Education & Other Professional Education Programs (broken down below) Freshman (first-year) standing Sophomore standing Junior standing Senior standing Post-Baccalaureate or alternatively-certified candidates Graduate level students 14. At what point are students able to be admitted into the School of Education?

5 15. Faculty/Staff Members at Institution Total Faculty/Staff Members Full-Time Faculty Part-Time Faculty Full-Time and Part-Time Staff 16. Number of full- and part-time faculty members in the education division whose highest earned degree is the following: Full-Time Part-Time Total Bachelors Masters Doctorate 17. Number of professional education degrees and certificates conferred by the institution for each of the past five years: Year* Bachelors Certificates M.Ed. MAT Specialist Doctorate Total *Begin with most recently completed academic year (September 1- August 31) 18. List organizations on your campus whose membership primarily include teacher education students. 19. Briefly describe unique institutional or teacher education programs, projects, and/or activities that encourage or enhance scholarship. 20. Are you aware of faculty and/or staff who are members of Kappa Delta Pi and who will serve as chapter members and/or mentors?

6 21. What is the level of support on your campus for starting a chapter of Kappa Delta Pi? Please speak to the willingness of other faculty members to assist with leadership responsibilities. This institution if granted a Kappa Delta Pi charter understands the following bylaws requirements for maintaining a chapter: Hold at least two meetings during the academic year. At least one meeting shall include an initiation of new members. Send a representative to at least one Society event (Convocation, ilead workshop, or other conference) over the course of two biennia (four years). Complete the Annual Financial Report no later than August 1 following the closing of the Society s fiscal year (July 1 June 30). Signature of Dean of Education/Division Head Printed Name of Dean of Education/Division Head Date (MM/DD/YYYY) Title Signature of Chapter Counselor/Advisor Printed Name of Chapter Counselor/Advisor Date (MM/DD/YYYY) Title

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