Member Registration

Email Address: The email address you will use to log in and receive verification codes.

Username: Required. 150 characters or fewer. Letters, digits and @/./+/-/_ only.

Password:

• Your password can’t be too similar to your other personal information.
• Your password must contain at least 8 characters.
• Your password can’t be a commonly used password.
• Your password can’t be entirely numeric.

Password confirmation: Enter the same password as before, for verification.

Display picture: Optional profile photo. JPG or PNG, up to 1 MB — it will be resized automatically.

Applicant Name: Your full first and last name.

Address: Your home street address.

City: The city you live in.

Zip Code: Your 5-digit home zip code.

Date of Birth: Your date of birth.

Phone Number: A phone number where you can be reached.

Name of Current School: The name of the school you currently attend.

Applicant Email Address: An email address for you (can be the same as your login email).

Your Current Grade: Your current grade in school, e.g. 10th.

School Activities Clubs/Interest: Clubs, sports, or activities you take part in at school.

Your Current Cumulative GPA: Your current overall GPA.

Are you interested in STEM programs? If So, Which Area? Science, Technology, Engineering, Mathematics: Whether you are interested in Science, Technology, Engineering, or Mathematics programs.

Are you interested in Summer Leadership Institutes? Whether you would like to join a Summer Leadership Institute.

What is your expected college major or trade? The college major or trade you expect to pursue.

Church Affiliation & Position(s) Held: Your church, if any, and any positions you hold there.

Community Involvement (List Awards & Certificates): Awards, certificates, or community activities you have taken part in.

Mother's Name: Your mother's full name.

Mother's Phone Number: Your mother's phone number.

Mother's Occupation: Your mother's occupation.

Father's Name: Your father's full name.

Father's Email Address: Your father's email address.

Father's Phone Number: Your father's phone number.

Father's Occupation: Your father's occupation.

Your Current Employer: Your current employer, if you have a job.

Position/Title Held: Your job title or position, if you have a job.

If I had an afternoon free with no homework, no chores, or other responsibilities, I would spend my afternoon.... Tell us how you would spend a totally free afternoon.

How will the Youth To Men group help you to develop into a better individual? Tell us how Youth To Men can help you grow as a person.

What contributions or talents can you offer Youth To Men? Skills or talents you can bring to Youth To Men.

What importance does post secondary education or the military have for you? How important college, trade school, or the military is to your future plans.

Please list your career goals and fields of interest. Your career goals and fields you are interested in.

First Reference — Name: Full name of an adult (teacher, counselor, neighbor, pastor) who can vouch for you.

First Reference — Phone Number: A phone number for that first reference.

First Reference — Email Address: An email address for that first reference.

Second Reference — Name: Full name of a second adult who can vouch for you.

Second Reference — Phone Number: A phone number for that second reference.

Second Reference — Email Address: An email address for that second reference.

What topic(s) would you like to learn about? Topics you would like Youth To Men to cover.

Cobb Works provides job training and other services. Would you like to learn more about the services offered? Whether you would like to learn about Cobb Works job training services.

Applicant, what is your shirt size? Your t-shirt size.