Be an Everyday Hero | African American Male Initiative

Everyday Heroes Registration Form

If you are a Black male interested in volunteering for the Steps to Success program, please fill out the form below. You can also download a printable form. Completed forms should be faxed to Laura Tomasko at 212-503-6806.

Personal Information (Required)

First Name: *

Last Name: *

Home Address

Home Address Line 1: *

Home Address Line 2:

City: *

State: *

Zip Code: *

Work Address

Employer: *

if student, enter school name

Position: *

Work Address Line 1: *

Work Address Line 2:

City: *

State: *

Zip Code: *

Phone and Email

Cell Phone: *

Work Phone:

Home Phone:

Email: *

How did you hear about Steps to Success or the African American Male Initiative:

How are you interested in volunteering:

Guest Speaker at Saturday Academy (once for 1.5 hours)

Escort Boys on Saturday Outings (4 hrs/trip)

Host group of boys at your office

Fundraising/ Sponsorships

Event Planning/ Promotion

Academic Assistance

Volunteer Recruitment

Website Development

Other ideas

Guest Speaker

Please fill out this section if you are interested in being a guest speaker at our Saturday Cultural Academy.

Contact me once opportunities become available

Brief Biography:

If you selected to be a guest speaker, please upload a brief biography.

Saturday Outing Escort

Please fill out this section if you are interested in escorting boys on Saturday outings

Availability:

Contact me once opportunities become available

Information for Research Puposes (Optional)

How do you describe yourself ethnically:

Age:

Highest Education Completed:

Income:

Universities Attended

College:

Masters:

PhD:

Law School:

Other Professional Degree:

For more information please contact

Laura Tomasko: 212.949.4969

Contact via email

African American Male Initiative

A Program of the Children's Aid Society

Everyday Heroes Registration Form

For more information please contact