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There will be a $25 non-refundable application fee to prospective members. Please make money orders payable to Progressive Black Men, Inc.

Progressive Black Men, Inc. Official Application for Membership

It is the individual's responsibility to present the most complete and professional application package possible. Application packages that are not complete or not representing the highest concepts and ideals of the organization will be rejected. Proposed Chapter Affiliation Full Name Date of Birth
Month Day Year

Current Address
Street Address City State ZIP

Primary Contact #

Secondary Contact #

Email Address

Permanent Address
Street Address City

Check if same as Current

State

ZIP

Military Service
Branch of Service Rank or Grade at Entry Any Declarations Date Entered Date Separated

Rank or Grade at Separation

Educational Background
Institution Program/Course of Study Current Collegiate Classification Location Degree College GPA College GPA Scale Yes No

Have you ever applied previously to Progressive Black Men, Incorporated?

If yes, please explain, in detail, the reason(s) you did not complete the New Member Education Program.

Have you ever been convicted of a felony?

Yes

No

(If yes, please attach an explanation).

Campus and Community Involvement

1. List Honors and Achievements you have received.

2. List organizations and other activities which you have been invovled with, and any offices held.

3. List all Volunteer Work activities you have been involved with in the last three years.

Other Documents
As a requirement for membership consideration a RESUME and an UNOFFICIAL TRANSCRIPT must also be submitted along with application.

Essay
A maximum 500 word typed Essay must accompany your Application for completion. Please note the topic below: I. "What Impact I Will Make in the Community Through Progressive Black Men, Inc."

Make sure everything listed below is either turned in with the membership application or that all requirements have been met. Failure to do so may result in disqualification of your application and thus not allowing you to be a member. Please initial each category completed. Have you written the one-page essay? Have you included your resume? Have you included the unofficial transcript? Have you included the $25 non-refundable processing fee?

PBM Membership Checklist

By my signature below, I certify that the information provided in this Application (and accompanying resume, transcript, essay, and documentation, if any) is true and complete. I understand that any false or misleading information or ommissions may disqualify me from further consideration for membership, or may lead to my dismissal, if discovered at a later date. Failure to sign below will disqualify you from being considered for membership.

_______________________________________________ __________
Signature of Applicant
Date
All information submitted to Progressive Black Men Incorporated will be held confidential and will become proprietary information.