PBI Real Men Lead Application

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Fields

Name*

First Name*

Initial (optional)

Last Name*

Student ID Number (if enrolled at Limestone)

Limestone University Email Address

Alternative Email Address (Gmail, Yahoo, other)*

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Phone*

What year are you in college?*

First year Second year Third year Fourth year

University Major/Minor*

Are you a student athlete at Limestone? If yes, which sport do you play?*

First Generation College Student Definition

An individual both of whose parents did not complete a baccalaureate degree.

Are you a First Generation College student?*

Yes No

What can Real Men Lead help you with? *

Mentoring Tutoring Summer Bridge Program Living Learning Community PBI Leadership Academy

Real Men Lead Contractual Agreement*

All Real Men Lead members are encouraged to participate in at least 3 workshops, academic events, peer mentor meetings, cultural activities, and service-learning projects per semester. All Real Men Lead members must adhere to policies of the Limestone University Student Handbook. All Real Men Lead members must collaborate with Program Staff.

FERPA Agreement Terms

The Family Educational Rights and Privacy Act is a federal law that protects the privacy of students education records. The law applies to all schools that receive funds under an applicable program of the US Department of Education. I am award that personal information provided to the Real Mean Lead program will be protected under the Federal Education Right & Privacy Act (FERPA) of 1974. No one will have access to the information unless they work with or for the Real Men Lead program.

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