XI CHAPTER OF ALPHA FRATERNITY, INC. I.. HANKINS/F.A. JOHNSON EDUCATION FOUNDATION YOUNG MEN OF DISTINCTION PROGRAM 2018-2019 PARTICIPANT APPLICATION P.O. BOX 555038, ORLANDO, FL 32855-5038 E: [email protected] P: 407.796.1906

Program Overview Alpha Phi Alpha Fraternity, Inc. through the Hankins/Johnson Education Foundation is dedicated to providing services and advocacy for our communities. The Young Men of Distinction (YMOD) program was designed to mentor middle and high school males in the areas of academic development, leadership development, personal development, and social development. Attention is given to these areas through monthly educational modules, social activities, fundraisers, and community services.

Program Eligibility Requirements  Middle and High School Male  Reside within the Central Florida Area (Orange, Seminole, Osceola County)  Minimum 2.0 Grade Point Average  Submit Program Application by September 10, 2018 via Email or Mail  Attend the mandatory Parents/Guardian and Participants Orientation Applicant Information First Name Middle Last Name

Street Address

City State Zip

Home Phone Cell Phone Email

School Name Grade Date of Birth (MM/DD/YY)

GPA (Weighted/Unweighted) Where you a 2017-2018 YMOD Shirt Size? (S,M,L,XL,2XL,3XL) Participant? (Yes or No) Are you employed? (Yes or No) If employed, what is your typical work schedule during the week?

Parent/Guardian Information First Name Middle Last Name

Street Address

City State Zip

Home Phone Cell Phone Email

Emergency Contact First Name Middle Last Name

Street Address

City State Zip

Home Phone Cell Phone Email

Why do you want to be a part of YMOD?

Please list any extracurricular activities you currently or have in the past participated in. Activity Year Activity Year

Please list any leadership positions you currently hold or have held in the past in the above activities. Leadership Position Year Leadership Position Year

Please list any community service activities you have done in the past. Community Service Activity Year Community Service Activity Year

PLEASE SUBMIT YOUR COMPLETED APPLICATION VIA EMAIL OR MAIL. E: [email protected] MAIL: YMOD, P.O. BOX 555038, ORLANDO, FL 32855-5038