Brother-2-Brother Application Form PERSONAL INFORMATIONStatusReturning StudentNew StudentName 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 StudyPrevious CollegeCourse of StudyCertificates / TrainingCertificates and/or Training that would be pertinent to your membershipLanguagesIf 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?YesNoOTHERHobbies 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 Date Format: MM slash DD slash YYYY
