The Male Success Initiative (MSI) is an enrichment program for male students of color at Governors State University, providing opportunities for professional, academic, and personal development. The MSI helps participants develop a game plan for success from orientation to graduation.

* 1. First Name

* 2. Last Name

* 3. Please indicate your ethnicity:

* 4. Cell Phone Number

* 5. Are you registered for the Fall 2017 term at GSU?

* 6. If you are registered, how many credit hours are you registered for?

* 7. Major:

* 8. Minor:

* 9. GPA (for returning students only):

* 10. Please indicate your academic classification:

* 11. Are you a Dual Degree Program transfer Student
(The Dual Degree program is for community college students who complete their Associate Degree at their respective community college and then transfer to a university (Governors State). DDP transfer students are formally accepted into the program before transfer.)

* 12. Please select one option below:

* 13. What is your employment status?

* 14. If employed, how many hours do you work per week (average)?

* 15. List on-campus activities and student organizations you have participated in (high school or community college, previous or present):

* 16. Please indicate the areas of particular interest to YOU (click all that apply)

* 17. Please write a brief statement highlighting your interest in the Male Success Initiative (150 words maximum):

* 18. Thank you for registering with the Male Success Initiative at Governors State University!

Join the MSI text messaging app by texting @msigsu to 81010. You will receive an immediate reply requesting additional information to complete your registration. You will then begin to receive text message updates and reminders about miscellaneous MSI activities, as well as any relevant GSU announcements.

T