Leadership & Sustainability Institute Membership Survey

Thank you for your interest in the Leadership & Sustainability Institute for Black Male Achievement (LSI). So we can best support you in the future, we are asking all members to please complete our 10-minute membership survey.

Filling out the survey will help the LSI team better understand your individual needs, and will also advance critical knowledge of the field of black male achievement across the country. We look forward to learning more about you and your work as we work together to ensure the growth, sustainability, and impact of leaders and organizations across sectors committed to improving the life outcomes of black men and boys through systemic change!

Onward,
Leadership & Sustainability Institute team

1. First Name *This question is required.

2. Last Name *This question is required.

3. Email Address *This question is required.

4. Phone Number

5. Organization Name *This question is required. Please enter N/A if this question is not applicable to you.

6. Program, Initiative, or Department Name Please fill this out if you are representing a program, initiative, etc. within a larger organization or institution (particularly if it has a connection to black male achievement.

7. When was the organization (or program/initiative) founded? Please enter a 4-digit year. This question requires a valid number format.

8. Website

9. AddressPlease enter in your personal address if not affiliated with an organization. Please note that it is required that you enter in your city and zip code.

Street
City
State
Zip

10. Position/Title

11. Gender (Optional)

12. Race/Ethnicity (Optional)Please check all that apply.

African American/ Black
Asian
Caucasian/ White
Hispanic or Latino

Native American
Native Hawaiian/ Pacific Islander
Other Please enter an 'other' value for this selection.

13. Primary Member Category *This question is required. Please select the primary category that most closely reflects your work.

14. Secondary Member Category If your work is reflected by more than one category, please select the secondary category here.

15. Has another representative of your organization already filled out a full LSI membership form?

16. Would you still like to fill out a full LSI member form to provide information about your individual work and needs?

Leadership & Sustainability Institute Membership Survey

Welcome