*Name
*Address
*City
*State
*Zip Code
*I am...
Faculty Staff
*BSU Email Address
*Office Extension
Phone Number (Optional)
*How did you hear about the BSU Male Initiative?
*Department
*Title
*Gender
Female Male
*Race
African American American Indian Asian
Caucasian Native Hawaiian/Pacific Islander Two or more races
*What language(s) do you speak other than English?
*List all of your extracurricular activities during your college years: (sports, student government, Greek, band, etc.-- on and off campus)
(Limit 200 Characters)
*What are your areas of study and or expertise?
(Limit 200 Characters)
*What are your hobbies?
(Limit 200 Characters)
*What are your areas of strengths? (Academic and Personal)
(Limit 200 Characters)
*Describe yourself in one sentence
Pledge
I solemnly promise to do the following as a committed participant of the BSU Male Initiative: To maintain active participation in the Initiative through the end of the Academic Year To do my part to facilitate the weekly contacts by my mentor; To actively work for my academic, personal, and social development. By checking the box below as my signature, I express my formal commitment

*Do you solemnly promise to do the above pledge as a committed participant of the BSU Male Initiative?
I agree to the above pledge
 
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