2013 Young Man Participant Application
"Becoming Men of Change"
July 12, 2013
9am-4pm
California State University, Sacramento

Description of BMoC Summit:
A FREE full day event focused on galvanizing community power and inspiring youth action! The purpose of the summit is to create system change by mobilizing young people and inspire dialogue between youth activists and local leaders regarding the development of a community action plan to improve health, safety and educational outcomes for Boys and Men of Color in the Sacramento area. At the end of the Summit participants will be encouraged to develop and sign a pledge demonstrating their commitment to work.

Qualifications and Requirements:
-   Applicants should be male, between the ages of 14-20 of any sexual orientation or gender expression/presentation
-   Applicants must commit to attending the entire summit at CSUS on July 12th
-   Must attend BMoC Family Day on July 13th, 10am-2pm LOCATION TBA
-   Selected applicants are encouraged to stay involved with the BMoC movement after the summit and maintain a relationship with their mentors. Events will be provided throughout the year to keep you involved!

*Please note that failure to respect the standards of the Boys and Men of Color Summit jeopardizes your participation within the summit.

**Deadline to submit is June 14th, 2013.


All applicants will be notified of their acceptance to the summit.

BMoC Summit Contact and Submission:

Christal West
Project Coordinator
Sacramento Building Healthy Communities
5709 Stockton Blvd
Sacramento, CA 95824

Phone: (916) 454-1892
Fax: (916) 454-1895
Email: christalBHC@asianresources.org


Registration is FREE (includes meals and program)
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Full name *
School/ Organization *
Preferred Mailing Address *
City *
State *
Zip/ Postal Code *
Birthdate *
Telephone *
Cell phone *
Email *
How did you hear about the Boys and Men of Color Summit?
Did you attend last year's summit?
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T-Shirt Size *
Ethnicity/ Heritage
Choose as many as you need
Primary languages spoken
Do you have any dietary needs?
If yes, please explain
Do you have any disabilities/ allergies or any other concerns that we should be aware of?
If transportation was made available, would you utilize it to get to the BMoC Summit? *
The Saturday after the summit, July 13th, is the Boys and Men of Color Family Day. Family day is "part two" of the BMoC Summit where all of those that attended can bring their families for a day of food, fun, and community building. If you are to attend, how many family members would you expect to bring? *
Student Responses
This section is optional. However, because our summit has limited space, we highly encourage you to complete this section to the best of your ability.
Why do you want to be a part of the Boys and Men of Color Summit? What do you hope to gain from this summit?
Please respond in essay format.
Tell us about your community and how you'd like to change it for the better?
Respond in whatever form you'd like (creative, poetry, story, essay, etc)
Please log on to www.sacbmoc.blogspot.com and download the "Release from liability, media recording and indemnification" form. Sign and submit via mail or send a scanned copy via email or fax to address below.
FOR MINORS UNDER AGE 18: Please have your parent/ guardian sign the form or you may not be able to attend. Mail or drop off signed forms to:

Sacramento Building Healthy Communities
5709 Stockton Blvd
Sacramento, CA 95820

Phone: (916) 454-1892
Fax: (916) 454-1895
Email: ChristalBHC@asianresources.org
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