Brother-2-Brother Application Form PERSONAL INFORMATIONStatus Returning Student New Student Name First Last Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail* EDUCATIONAL INFORMATIONHigh School* Course of Study Previous College Course of Study Certificates / TrainingCertificates and/or Training that would be pertinent to your membership LanguagesIf you are fluent in any languages besides English please list: Current GPA / GPA you are seeking? Mentoring / Leadership ProgramHave you ever been involved in a Male Mentoring / Leadership program? If so explain:1st Generation college student? Yes No OTHERHobbies or Interest: Avallability*Brother-2-Brother seeks eligible minority male students committed to success through the initiative. In doing so, participants are expected to make a concerted effort to attend designated functions geared at student success. Commitment requires some evening hours and off-campus field trips. Some requirements may include MANDATORY tutoring or mentoring. Please indicate hours AVAILABLE:Disability or Special need accommidations? If yes explain. How did you hear about B2B? Authorization - Participants Signature*By signing below I verify the above information is true. I understand that any false information is grounds for denying or termination from B2B. I understand participation in the B2B program will not affect my academic performance with college faculty and does not provide preferential classroom sanding. Date MM slash DD slash YYYY
