FBL Inc Advisory Committee

Full Name

First NameLast Name

Email

Please enter the best email to contact you (example@example.com)

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

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.)

When our Mentorship Program launches, would you be interested in serving as a mentor to a college student?

How much time could you comfortably commit per month to advisory activities?

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:

Your headshot will be added to our website, along with your LinkedIn.

Is there any additional information you'd like to share? Feel free to include any of your memberships, specialties, skills, etc.