ADVISORY BOARD SUBMISSION FORM

I elect to become a member of the Kinte Center Advisory Board and I submit the following personal Data.

Name:
Address:
Work Phone:
Home Phone:
Cell Phone:
Email Address:
My highest level of education (1 thru?):
Type of Degree:
Area of Specialization:
What is your current Occupation:
Current Job Title:
COMPUTER LITERACY: Check the area(s) below that you are computer literate in (NOTE: Computer literacy is not a requirement)	Word Excel E-mail Internet None
REFERRED BY (if referred):
Would you be able and willing to accompany Kinte Center members of volunteers to meetings with City Council Representatives, City Commission and Oakland City Council etc.	Yes No