FBL Inc Advisory Committee
Full Name
*
First Name
Last Name
Email
*
Please enter the best email to contact you (example@example.com)
Phone Number
Please enter a valid phone number.
Current City & State
*
Example: Indianapolis, IN; Cincinnati, OH; etc.
Current Employer?
*
Please enter the organization(s) you currently work with?
Current Job Title?
*
Please enter your current position or role
Industry Experience
*
Please list the industries you’ve worked in (e.g., healthcare, education, business, technology, etc.).This helps us align your expertise with potential mentorship and networking opportunities.
What areas do you feel most equipped to contribute to as an Advisory Committee member?(Select all that apply.)
Career mentorship
Fundraising / sponsorship outreach
Event planning / community engagement
Professional development programming
Marketing / communications
Organizational strategy / governance
Health & wellness education / healthcare initiatives
Diversity, equity & inclusion advocacy
Other: ___________________________
When our Mentorship Program launches, would you be interested in serving as a mentor to a college student?
*
Yes
No
Maybe — I’d like to learn more
How much time could you comfortably commit per month to advisory activities?
1–2 hours
3–5 hours
6+ hours
It depends on the season / schedule
N/A
Have you had prior involvement with Future Black Leaders? If yes, please explain. If no, please enter "N/A".
*
Please provide your LinkedIn account.
*
Please share your LinkedIn URL. Your profile may be featured within our College Network and on our website.
Please provide a professional headshot of yourself:
*
Browse Files
Drag and drop files here
Choose a file
Your headshot will be added to our website, along with your LinkedIn.
Cancel
of
Is there any additional information you'd like to share? Feel free to include any of your memberships, specialties, skills, etc.
*
Submit
Should be Empty: