Kudos and Xinos Registration

National Sorority of Phi Delta Kappa, Inc.
“To Foster a Spirit of Sisterhood Among Teachers and to Promote the Highest Ideals of the Teaching Profession”
Far Western Region
54th Xinos/Kudos Youth Leadership Conference
- Dr. Elcendia Nord, Regional Director
- Dr. Etta F. Carter, Supreme Basileus
- Anona Huntley, National Youth Coordinator
- Ruth Curry, Member-at-Large
- Emily Wade Thompson, Beta Nu Basileus
- Eva Allen, Conference Coordinator
Conference Theme: Speak Up! How to Build Confidence as African American Youth in the 21st Century
Date: Saturday, April 10, 2021
Location: San Francisco, CA - Virtual Conference

CHAPTER REGISTRATION FORM
To be completed by Chapter Representative only
Chapter's Name
Chapter Basileus
First NameLast Name
Email
example@example.com
Xinos President
First NameLast Name
Email
example@example.com
Kudos President
First NameLast Name
Email
example@example.com
Xinos Vice President
First NameLast Name
Email
example@example.com
Kudos Vice President
First NameLast Name
Email
example@example.com
Xinos Recording Secretary
First NameLast Name
Email
example@example.com
Kudos Recording Secretary
First NameLast Name
Email
example@example.com
Xinos Corresponding Secretary
First NameLast Name
Email
example@example.com
Kudos Corresponding Secretary
First NameLast Name
Email
example@example.com
Xinos Treasurer
First NameLast Name
Email
example@example.com
Kudos Treasurer
First NameLast Name
Email
example@example.com
Other PDK Member Attendee (Please skip to the end of the registration form and submit)
First NameLast Name
Email
example@example.com

XINOS/KUDOS REGISTRAION FORM
To be completed by Chapter Representative only
Xinos Advisor
First NameLast Name
Kudos Advisor
First NameLast Name
EmailPhone
EmailPhone
Register participants here:
Identify the number of graduating seniors:

FACT SHEET
To be completed by Chapter Representatives only
Date
MonthDayYear
Date
The National Sorority of Phi Delta Kappa, Inc. is a professional organization of well-trained and effective educators in five regions of the United States, and two International Chapters located in Monrovia Liberia, West Africa and Barbados, West Indies.
One aspect of the Sorority’s Y.E.S. (Youth, Education, and Service) program is Youth Guidance. Its major components include leadership-training, development of strategies and study methods aimed at academic enhancement, social growth and participation in community service. An annual conference is held in order to facilitate the youth in these areas of development.
At the conference the Xinos (high school females) and Kudos (high school males) will compete in various activities and attend relevant workshops that address positive aspects of personal and academic development.
There are approximately 50-70 young people in attendance at each conference who return to school highly motivated to enhance their academic, social, and personal achievement.
Chapter's Name
Advisor
First NameLast Name
Advisor Signature
Clear

INTERNET/MEDIA PERMISSION FORM
National Sorority of Phi Delta Kappa, Inc.
Beta Nu Chapter
San Francisco, California
Internet/Media Permission Form
Student Pictures/Names used in various forms of media

For your protection and privacy, we ask permission to use your child’s picture within our sorority web site and other media should we desire. Pictures used on the web site or other media will include Xinos and Kudos when they are involved
In projects, in large groups, when their group receives recognition at the youth conference or other Sorority related activities.

Media includes, but is not limited to, newspapers, magazines, internet, video, and television.
Please check all that apply. Sign, and return to Beta Nu Chapter’s Advisor.
I give my permission to use my child’s picture on the internet with his/her name.I give permission to use my child’s picture in the media.I give my permission to use my child’s art work, written paper, and computer projects on the internet.I understand that the media images may be used for advertising or marketing purposes.Do not use my child’s picture on the internet/media.Do not use my child’s written work on the internet/media.Do not include my child’s name on the internet/media.I acknowledge that I have legal authority to sign this form on behalf of the minor student participating in this activity.
Name of Student
First NameLast Name
Other
Student Date of Birth Any Restrictions
Name of Parent/Guardian
First NameLast Name
Signature of Parent/Guardian
Clear
Date
MonthDayYear
Date

RULES OF CONDUCT CONTRACT
Virtual Rules of Conduct Contract

Participants must attend meetings, activities, and participate in educational events.

All cell phones and electronic devices MUST be used for youth conference activities. Full attention is expected by all attendees.
1. Cyber Bullying and/or Harassment
a. Sending or posting discriminatory, harassing, or threatening messages or images via chat.
b. Sending or posting messages that defame or slander other individuals via chat.
c. Engaging in harassment based on a student’s membership in a protected class (race, color, religion, national origin, sex, sexual orientation, gender identity, age or disability).

2. Disruptive and/or Disrespectful Virtual Behavior
a. Conduct or behavior which interferes with or disrupts the teaching and learning process.
b. Refusing to follow the rules of the specific virtual environment.
c. Unmuting yourself when the advisors has placed you on mute.
d. Conduct or behavior which embarrasses a person or group of persons.
e. Inappropriate use of discussion forums or synchronous chat rooms.
f. Posting or discussing any criminal or other illegal activity including encouraging the unlawful use, possession, manufacture or distribution of tobacco, drugs, or alcohol.

3. Dress Code
a. Suggestive, provocative or excessively tight clothing is not allowed to be worn on camera during instructional activities.

4. Electronic Device Misuse
a. Recording any sessions and transmitting it.
b. Recording the advisors and/or classmates.

5. Threat to Adult or Student and or Extortion
a. Expressing a threat orally, in writing, or by gesture with the intent to do physical harm to others is a crime.

Participants who disobey rules will be excluded from the conference. I have read the Rules of Conduct Contract and agree to abide by the rules.
Xinos/Kudos Signature
Clear
I/We have read the above contract and understand that I/We must abide by the rules. Parent/Guardian Signature
Clear
Cell Phone Number
Area CodePhone Number
Should be Empty:

CHAPTER REGISTRATION FORM

XINOS/KUDOS REGISTRAION FORM

FACT SHEET

INTERNET/MEDIA PERMISSION FORM

RULES OF CONDUCT CONTRACT