Future Black Leaders Black Student Union (BSU) Leadership Committee Application
Future Black Leaders is creating a statewide network of Black student leaders to help shape programs, provide student perspectives, and assist in planning initiatives such as the Black Leadership Summit, College Prep Program, Black Round Table, and other leadership opportunities. Committee members will:Help plan and promote FBL eventsProvide feedback on student needs and concerns Connect FBL with their school communitiesCollaborate with student leaders from across IndianaGain leadership, networking, and professional development opportunities
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Personal-information questions
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date Of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Are you at least 18 years old?
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Yes
No
Which best describes you?
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Please Select
High school student
College student
Graduate student
College graduate or alumnus
School, College, University, Employer, or Organization
*
Current Grade or Classification
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Please Select
9th grade
10th grade
11th grade
12th grade
College freshman
College sophomore
College junior
College senior
Graduate student
Not applicable
Expected Graduation Year
*
Major or Area of Study
City
*
State
*
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Parent or Guardian Information
Parent or Guardian Full Name
*
First Name
Last Name
Parent or Guardian Email Address
*
example@example.com
Parent or Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Applicant
*
Please Select
Mother
Father
Legal guardian
Grandparent
Other
Because you are under 18 years old or currently enrolled in high school, your parent or legal guardian must review and approve your participation. After you submit this application, Jotform will automatically email the parent or guardian listed above with instructions to provide an electronic signature.
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Leadership experience
Are you currently involved with Future Black Leaders?
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Yes
No
Not yet, but I am interested
Are you involved with any of the following?
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Black Student Union
Student government
Fraternity or sorority
Community organization
Nonprofit organization
Church or faith-based organization
Health organization
Other
Have you participated in an a FBL event before?
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Yes
No
Which school or organization hosted the event?
*
Why are you interested in joining the FBL Committee?
What skills, experiences, or connections would you bring to the committee?
What ideas do you have for making FBL more impactful?
Tell us about an event, project, or initiative you have helped organize.
Is there anything else you would like our team to know?
Approximately how much time can you commit each month?
*
Please Select
1–3 hours
4–6 hours
7–10 hours
More than 10 hours
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Committee-Interest
Which areas are you interested in supporting?
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Black Leadership Summit Committee
Campus outreach and communication
Event coordination
Marketing and social media
Graphic design
Photography and videography
Public relations
Sponsorships and fundraising
Health education
Community and nonprofit partnerships
Survivor and family engagement
Volunteer coordination
Merchandise
Logistics and materials
Website and technology
Data and impact tracking
General committee support
Other
Which three areas interest you most?
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Would you be interested in leading a committee area?
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Yes
No
Maybe
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Availability
Committee meetings will generally be held virtually every other week. Can you regularly attend?
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Yes
I can attend most meetings
My availability varies
No
May Future Black Leaders contact you regarding this application and BCAM committee activities?
*
Please Select
Yes
No
Would you like to receive emails about FBL scholarships, programs, events, leadership opportunities, and future initiatives?
*
Yes, I would like to subscribe
No, not at this time
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Final Agreements
By Submitting This Form
*
I certify that the information provided is true, accurate, and complete to the best of my knowledge.
I understand that submitting an application does not guarantee committee selection.
I understand that committee participation is voluntary.
I understand that applicants who are under 18 or enrolled in high school must receive parent or guardian approval.
I authorize Future Black Leaders to contact me regarding my application.
Submit
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