Help lead the future.

Name *

First Name

Last Name

Phone *

Country

(###)

###

####

Were you born between 1997-2012? *

Yes

No

Do you identify as Black or African American? *

Yes

No

Do you have at least six months of leadership experience in an administrative role at an HBCU? *

Yes

No

Are you affiliated with an HBCU, either as a current professional or within the last five years? *

Yes

No

What is/was your department? *

Student Affairs & Engagement

Enrollment Management & Admissions

Financial Aid & Student Support Services

Athletics Administration

Counseling & Wellness Services

Other

Are you willing to participate in a semi-structured interview lasting approximately 45–50 minutes via Zoom? *

The interview will be recorded for transcription and analysis purposes. By agreeing to participate, you also agree to confidentiality measures in place, including the use of pseudonyms.

Yes

No

Disclosure & Consent Statement *

Confidentiality Assurance Your participation is confidential. Your name and personal information will not be shared publicly or linked to your responses in any way. Data Security All information collected through this form is securely stored and accessible only to the research team. No personally identifiable data will be made public. Purpose of Information Collection The information you provide will only be used to determine eligibility and coordinate participation in this research study. It will not be shared with any third parties. Voluntary Participation Filling out this form does not obligate you to participate. You may withdraw your interest at any time without penalty or consequence. Minimal Data Collection We only ask for the necessary contact information to follow up with you about the study. You are not required to provide any additional personal details beyond what is needed for participation. IRB Compliance This study has been approved by the Institutional Review Board (IRB) at Indiana Institute of Technology, ensuring that all ethical guidelines for participant privacy and protection are followed.

I have read and understand the above information. I consent to provide my contact details for potential participation in this study.