2016 BMoC Youth Application
We Are More Than A Statistic
5th Annual BMoC Summit; July 21st, 2016
Sacramento State Alumni Center, 9:00AM-4:30PM

YOUTH APPLICATION
(Ages 14-18)
Description of BMoC Summit:
A FREE full day event focused on galvanizing community power and inspiring youth action! The purpose of the summit is to create system change by mobilizing young people and inspire dialogue between youth activists and local leaders regarding the development of a community action plan to improve health, safety and educational outcomes for Boys and Men of Color in the Sacramento area. At the end of the Summit participants will be encouraged to participate in in goi8ng BMoC activities and events.
Qualifications and Requirements:
• Applicants should be male identified, between the ages of 14-18, of any sexual orientation or gender expression/ presentation
• Applicants must commit to attending the entire summit at CSUS on July 7th, 2016
• Selected applicants are encouraged to stay involved with the BMoC movement after the summit and maintain a relationship with their mentors. Events will be provided throughout the year to keep you involved!

Please note that failure to respect the standards of the Boys and Men of Color Summit jeopardizes your participation as a Mentor. Deadline to submit is June 10th, 2016
Name: *
(First, Last)
Your answer
Date of Birth: *
(Month/Day/Year)
Your answer
Address: *
(Street, City, State, Zip Code)
Your answer
Phone Number: *
(XXX) XXX-XXXX
Your answer
Email: *
Your answer
What is your t-shirt size? *
Please choose one:
Instagram Name:
(Optional)
Your answer
Twitter Name:
(Optional)
Your answer
School/Organization *
Your answer
How did you hear about the BMoC Summit? *
Your answer
Did you attend the BMoC Summit last year? *
Do you need transportation to get to the BMoC Summit? *
Do you have any disabilities, allergies, conditions, and/or concerns that we should be aware of? *
Your answer
Do you have any dietary needs? *
Your answer
What is your race/ethnicity? *
Your answer
What is your primary language spoken? *
Your answer
Why do you want to be a part of the Boys and Men of Color Summit?
(This section is optional. However, because our summit has limited space, we highly encourage you to complete this section to the best of your ability.)
Your answer
What do you hope to gain from this summit?
(This section is optional. However, because our summit has limited space, we highly encourage you to complete this section to the best of your ability.)
Your answer
Tell us about your community and how you’d like to change it for the better? *
Respond in whatever form you’d like (creative, drawing, poetry, story, essay). Please send it to: bhc@asianresources.org with your full name in the header if you are unable to put your answer in the box below.
Your answer
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