Brother-2-Brother Application Form

PERSONAL INFORMATION
Status
- Returning Student
- New Student
Name
First Last
Address*
Street Address City State ZIP Code
Phone
Email*
EDUCATIONAL INFORMATION
High School*
Course of Study
Previous College
Course of Study
Certificates / Training
Certificates and/or Training that would be pertinent to your membership
Languages
If you are fluent in any languages besides English please list:
Current GPA / GPA you are seeking?
Mentoring / Leadership Program
Have you ever been involved in a Male Mentoring / Leadership program? If so explain:
1st Generation college student?
- Yes
- No
OTHER
Hobbies 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

PERSONAL INFORMATION