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