EMBODI Interest Form
EMBODI stands for "Empowering Males to Build Opportunities for Independence," and it is a program that will help young men start their journey to becoming responsible, independent and productive members of their communities.Young Men Will Learn More About: 🌟 Leadership 🎓 College and Career Readiness🧠 Physical and Mental Health 🧑🏾🦱Life Skills 💵 Money Management and 🥗 Healthy Lifestyle Choices. Our Theme is: Building Black Excellence: Future Kings Rise Up! *Please complete the interest form for the young men who would like to participate.
Student Information:
Student Name
*
First Name
Last Name
Student School
*
Student Grade
*
Student Name 2
First Name
Last Name
Student School 2
Student Grade 2
Student Name 3
First Name
Last Name
Student School 3
Student Grade 3
Primary Parent/Guardian Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Alternate Parent/Guardian Name
First Name
Last Name
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
What are you interested in gaining from this program?
Please list any special interests that you have.
Please share any questions, comments and or concerns.
Submit
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