Core Group Application
Application for United Black Ellument's Core Group. Join a team of passionate individuals ages,18-35, that seek to improve the lives of other black gay and bisexual guys in our community. Together with the project coordinators, you will help plan events, distribute safer sex supplies (like condoms) to men, and be a role model that inspires others.

Core Group is a commitment, and will require attending weekly meetings, participating in social events and being willing to work your selected tasks throughout the commitment. If joining Core Group is of interest to you and you identify as a Black Gay/Bisexual Man between the ages 18-35, please fill out the application below.
Email address *
Contact Information
Applicant Demographic information, please answer all the questions listed below.
Name *
Birthdate *
MM
/
DD
/
YYYY
Age *
Phone Number
Address
City *
State *
Zip Code *
Gender/Preferred Pronouns - select Gender and Pronoun *
Emergency Contact Information
Please list a person whom we can contact in case of an emergency.
Emergency Contact Name *
Emergency Contact Phone Number *
Emergency Contact Relationship (For example: Brother, Sister, Mother...) *
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy