Diverse Male Scholar Initiative Referral Form
This form serves as a tool staff, faculty, and administrators can use to refer students to the Diverse Male Scholar Initiative (DMSI). DMSI works alongside students to develop unique programs and workshops throughout the year, which promote a sense of belonging, camaraderie, and a contemporary understanding of what it means to navigate life as self-identified men of color.

Mission: The Diverse Male Scholar Initiative (DMSI) at College of the Redwoods and Humboldt State University 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 Devon Hernandez (dmh130@humboldt.edu).
Sign in to Google to save your progress. Learn more
Email *
Name of Referring Professional: *
College/University: *
First name of student you are referring: *
Last name of student you are referring: *
Student's email: *
Student's ethnicity: *
Student's class standing? *
Why would you like to connect this student to DMSI? Please be as descriptive as possible. *
Is there anything else you would like us to know about the student?
Do you have any comments or questions?
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Cal Poly Humboldt. Report Abuse
Google Forms