Name
*
First Name
Last Name
Gender
*
Female
Male
Nonbinary
Prefer Not To Answer
Date of Birth
*
MM
DD
YYYY
University
*
Brown University
Columbia University
Cornell University
Dartmouth College
Harvard University
University of Pennsylvania
Princeton University
Yale University
Degree Level
*
Undergraduate
Graduate
Undergraduate and Graduate
Class Year
*
2036
2035
2034
2033
2032
2031
2030
2029
2028
2027
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
Email
*
Phone
*
Country
(###)
###
####
If answered "Other" above: Please list where you're based using the format "City, State Abbreviation" (if based in the US) or "City, Country" (if based outside of the US)
Dietary Restrictions
*
Gluten-Free
Halal
Kosher
Nut-free
Pescatarian
No Dairy
No Eggs
No Fish
No Seeds
No Soy
Vegan
Vegetarian
No Beef
No Pork
None
Other
If answered "Other" above: Please indicate your dietary restriction(s)
Industry
*
Agriculture
Art and Design
Automotive
Business Management
Construction
Consulting
Education
Energy
Engineering
Entrepreneurship/Startups
Environmental Services
Entertainment/Media
Fashion
Finance
Fitness and Wellness
Food and Beverage
Government/Public Administration
Healthcare
Hospitality
Legal Services
Manufacturing
Marketing/Advertising
Real Estate
Research/Science
Retail
Social Services/Nonprofit
Student
Technology/IT
Telecommunications
Transportation/Logistics
Travel and Tourism
Looking For An Opportunity
Other
If answered "Other" above: Please list the industry you work in.
What is your dream aspiration?
*
*Please be detailed
How did you hear about BLACKIVY?
*
From A Member
Instagram
My School
Tik Tok
Website
Word Of Mouth
Other
Why do you want to join BLACKIVY?
*
*Please be detailed in your response including how you believe you will benefit the BLACKIVY community and how you believe the BLACKIVY community will benefit you.
Are you interested in joining any of the following BLACKIVY teams/groups?
*
Communications & Newsletter
Community Service Planning
Community Service Volunteering
Experience Planning
Experience Volunteering
Fundraising
Live Music / DJs
Marketing & Social Media
Membership Recruitment
Photography / Videography
Sponsorships & Partnerships
Technology
Data Use Confirmation
*
By submitting this application, I hereby acknowledge and consent that BLACKIVY will collect, store, and use my personal information for internal purposes. These purposes include, but are not limited to, outreach, experience planning, marketing initiatives, and enhancing the overall experience for BLACKIVY members. I understand that BLACKIVY will protect my information in accordance with applicable privacy laws and will not share it with external parties without my explicit consent unless required by law.
I Confirm