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Rising 100 Student Application
Step Into Leadership. Prepare for College, Career, and Life.

The Rising 100, presented by 100 Black Men of the Bay Area, is a mentoring and leadership initiative for African American boys in grades 9–12 across the Bay Area. This program builds leadership skills, life readiness skills, and cultural pride, including the opportunity to participate in our HBCU College Tour. Please complete this form carefully. Space is limited and the Fall 2026-27 program begins in August 2026.
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Student First Name *
Student Last Name *
Preferred Name/Nickname *
Grade Level *
School Name *
Date of Birth *
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Student Phone Number *
Student Email Address *
Parent/Guardian Full Name *
 Parent/Guardian Phone Number *
Parent/Guardian Email Address *
Mailing Address *
Why do you want to join the Rising 100? *
Special Interests or Career Goals *
T-Shirt Size *
Emergency Contact Name *
Emergency Contact Phone Number *
Medical Conditions or Allergies *
How did you hear about the Rising 100? *
Parent/Guardian Consent *
Required
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