*Name
Address
Phone Number (Optional)
*BSU Email Address
How did you hear about the BSU Male Initiative?
*Campus Residence
YES NO
Residence Hall Name
Citizenship
Permanent Resident U.S. Citizen
*Gender
Female Male
*Age
*Race
African American American Indian Asian
Caucasian Native Hawaiian/Pacific Islander Two or more races
What is your current marital status?
Divorced Married
Separated Single
*In-State or Out-of-State
In-State Out-of-State
International Student
YES NO
What language(s) do you speak other than English?
Transfer Student
Yes No
Transferred From
*Year at BSU
1st 2nd 3rd 4th 5th 6th
Anticipated Graduation Date
*Enrollment Status
Undergraduate Graduate
*Level of Study
Bachelor's Doctorate Master's
*Assigned Academic Advisor
Major
Minor
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 career plans? (Be as specific as possible)
(Limit 200 Characters)
What are your hobbies?
(Limit 200 Characters)
What are your areas of strengths? (Academic and Personal)
(Limit 200 Characters)
What are your desired areas of improvement? (Be as specific as possible? 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
 
* indicates a required field