Diverse Male Scholar Initiative Interest Form

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Thank you for your interest in joining the Diverse Male Scholar Initiative (DMSI). We appreciate your desire to learn more, and become a part of a new program that strengthens the support given to self-identified men of color. If you have an interest in participating in our programs, and would like to a part of the active roster, please fill out the following form.

Mission: The Diverse Male Scholar Initiative (DMSI) at College of the Redwoods and Humboldt State University and is designed to cultivate a safe community for self-identified male students of color by providing culturally centered programs strengthened with academic achievement, holistic development, community building, and leadership opportunities.

Vision: DMSI commits to the social, academic, and professional growth of self-identified men of color. Utilizing our Pillars of Success, DMSI will actively work alongside campus and community stakeholders to create student-centered programs that promote growth and wellbeing.

If you have any questions feel free to contact us (dmsi@humboldt.edu).

Email *

First Name: *

Last Name *

Preferred Pronouns *

College/University *

College of the Redwoods

Humboldt State University

Student ID Number *

Cell Phone #: *

What is your preferred method of communication? *

Text

Call

All Forms are Good

Required

Ethnicity *

Black/African American

Latino/Hispanic/Chicano

Asian

Native American

Pacific Islander

Other:

What is your current class standing? *

Freshman (0-29.9 units)

Sophomore (30-59.9 units)

Junior (60-89.9 units)

Senior (90 - or more units)

Graduate Student

What is your major(s)/minor(s)? *

What are your career/professional/graduate school interests? *

If you are a Veteran, would you like to get connected to Veterans Services? *

Yes

Not Applicable

If you have disabilities, would you like to get connected to Disability Services? *

Yes

Not Applicable

If you have been impacted by Academic Probation, Disqualification or Reinstatement? *

Yes

Not Applicable

What are your hobbies and areas of interests? *

Why would you like to be a part of this program? Please be as descriptive as possible. *

In a time of online learning, how can DMSI add value to your life? *

Name any Services/Organizations you are a part of (RAMP, EOP, SHPE, Athletics, GROVE, CalWorks etc.):

Do you have any comments or questions?

Submit

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