Black Panther Party of San Diego Chapter   Application for Membership Consideration
This form is required to be a recruit applicant. This application will not be shared with other entities and is strictly confidential and used for internal processing to prescreen your membership eligibility, as well as maintain a record for identification in the event of any field emergencies. Please provide accurate information for use with this application. There is a non refundable $25 processing fee, to be submitted if your membership is approved due at graduation. Your appointed panther sponsor will contact you regarding your application status, recruitment training requirements, and schedules.

Non-compete Clause: You agree that you will not form another Black Panther formation. In the event you part with the organization, the security of the Black Panther Legacy will remain in the care of the Black Panther Party of San Diego.

IF YOU DO NOT WISH TO FILL OUT THIS FORM YET, please attend one of our in-person events to learn more about the organization before joining. 

Meet & Greet Dates:
June 22, 2024
2pm-4:30pm 
Logan Heights Library 

July 20, 2024
2pm-4pm
Malcolm X Library (Seminar Room (A-B)

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Email *
Full Name *
Other names or aliases you are known by
Date of Birth ( MM/DD/YYYY) *
MM
/
DD
/
YYYY
State Driver’s License/ID Number & State Issued
Current Address
Mobile Phone Number *
Do you have any physical limitations? If yes, please explain.
Have you been diagnosed with any mental illnesses? If yes, please explain.
How long have you lived in the San Diego Country area? *
Why are you interested in becoming a Black Panther? *
Have you served under any other Black Panther Formation?
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If yes, please explain why you are no-longer operating under that formation?
Briefly describe what you expect out of your involvement with the Black Panther Party?  

Do you currently know any members of the Black Panther Party or The Panther Party?  If so please list their names, BPP or TPP chapters, and your relationship to each  member:

Do you have any pending criminal charges against you?
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If yes, please explain
Do you know any of our current membership? If so, please describe your history and relationship to them.
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