BMI Membership Intake Form

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Thank you for your interest in joining the Black Midwest Initiative. We look forward to following up with you within 30 days of submission of your form.

Email *

First name *

Last name *

Current residence (City, State) *

Applicant type (check all that apply) *

Undergraduate student

Graduate or professional student

Postdoctoral scholar

College or university instructor or faculty member

Retired/emeritus faculty member

Independent scholar

Artist/creative

Organizer/activist

Community member

Other:

Required

Institutional affiliation (if applicable)

Are you in agreement with the mission, values, and vision of the Black Midwest Initiative? *

Yes

What is your relationship to Black midwestern communities and why are you interested in joining the Black Midwest Initiative? *

Are you interested in serving on any of the following committees? (check all that apply)

Note: Anyone who serves on a subcommittee will be invited to become part of the Council. The Council meets virtually three times a year and is responsible for overseeing and making decisions about the overall direction of the organization.

Executive Committee: Meets at least once a month. Responsible for overseeing and making decisions about the day-to-day activities of the organization and for steering the implementation of decisions made by the Council.

Symposium Committee: Meets as needed. Responsible for planning and implementing the biennial symposium. (This committee is led by a steering committee that includes the lead organizers from the host city.)

Scholarship Committee: Meets as needed. Responsible for drafting the call, reading applications, and choosing the final recipients of the David C. Smith Memorial Scholarship.

Membership Committee: Meets as needed. Responsible for communicating with and recruiting individual and organizational BMI members.

Finance Committee: Meets as needed. Responsible for overseeing the financial health of the organization and developing opportunities for funding.

I am not interested in sitting on a committee at this time.

Required

Annual dues for membership in BMI range between $25-$75, depending on your membership type. Are you willing to pay dues in support of BMI? (We will follow-up later with information about how to process your dues payment.) *

Yes

How did you learn about the Black Midwest Initiative? (check all that apply) *

Institutional email

Social Media

Black Midwest Symposium

BMI member

Friend or colleague

BMI website

Other:

Required

Any questions or other information you would like to share? (optional)

Send me a copy of my responses.

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