CCBSA CONNECTION FORM
The collection of Black Staff information is to assist with building and connecting the Black Capitol Community.
Email address *
First Name *
Your answer
Last Name *
Your answer
Personal Phone *
Please use this format: XXX-XXX-XXXX
Your answer
Personal Email *
Please enter a valid email address
Your answer
EDUCATION
University or College *
Your answer
Course of Study *
Your answer
Degree Obtained *
Required
Where are you currently employed? *
Your answer
What is your current position? *
Your answer
In which areas would you like more training?
Your answer
What is your short term career goal?
What is your long term career goal?
FUTURE CAREER GOAL
Your answer
Twitter Handle *
Your answer
Facebook? *
Your answer
Instagram Handle *
Your answer
Are you connected to CCBSA's Twitter & Facebook page? *
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