Date:
Donald E. Aldrich, Chief Executive Ocer
Tau Kappa Epsilon Fraternity
7439 Woodland Drive
Indianapolis, IN 46278
RE: Request for Inactive Status
Dear Frater,
I, ________________________ of the _____________________ chapter request in accordance with Article
VI, Sec. 3 of the Fraternity’s Black Book approval from the Tau Kappa Epsilon Fraternity Inc’s Chief Executive
Ocer to approve my membership status as Inactive in said organization.
Select one reason for your request: _____________________________________________________________
I understand that the Chief Executive Ocer may require sucient documentation verifying the conditions
of my request. I further acknowledge that an inactive member shall have none of the rights or privileges of
an active, honorary or alumni member. Furthermore, I may only be restored active status should my chapter
approve this with a two-thirds vote. I also understand and stipulate that I am responsible for any and all dues
and fees that are outstanding, as of the date of this request.
Yours In e Bond,
Name (Print) Name (Signature) Scroll Number Date
Required Acknowledgments:
I, ________________________ as Chapter Prytanis and I, _____________________ as Board of Advisor
Chairman, acknowledge the request made by _____________________ for inactive status. We further acknowl-
edge that the Oces of the Grand Chapter will not make any adjustments to the Chapter’s Risk Management
and/or other Assessment Fees.
Signature Acknowledgment and Dated:
Name (Print)
Name (Signature) Date
Name (Print) Name (Signature) Date
For Internal Use Only
Exception Requested (Why not returned?)
NoYe s
Badge Returned: NoYe sMembership Certicate Returned:
Reasons for Denial: NoYe sCEO Approval: CEO Initials & Date:
CEO Signature for Approval: Date: Systems processed by: Date:
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