#Pray4HBCUs Request

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REQUEST

Full Name (include applicable suffixes and credentials)

Mailing Address

HBCU Affiliation *

I'm a future HBCU Student.

I'm an HBCU Student/Graduate.

I'm an HBCU Faculty/Staff.

I'm an HBCU Administrator.

I'm an HBCU Board Member.

I've no direct HBCU Affiliation.

Personal Email Address

Phone

Organization Interest

I'm interested in becoming a Member of Rdevia.

I'm interested in joining the Board of Visitors.

I'm interested in being a Scholarship Judge.

I'm interested in being an HBCU Mentor.

I'm interested in applying for scholarships or mentorship.

I've other interests, please follow up with me.

HBCU Information

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Name

Mailing Address

Email

Phone

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