Brothers of Excellence Application

Indicates required field

First Name

Middle Name

Last Name

Address

City

State

Zip

County of Residence

Phone Number

What form of communication do you prefer, when connecting with your mentor

Are you willing to meet your mentor on a CCCC campus at least twice a year

Race (check all that apply)

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Other…

Are you a first generation student

What is your age group

Are you a new student at CCCC

What is your high school GPA (write N/A If you received a GED)

What is your field of study (major)