University Sponsor Form| Black Music Therapy Network, Inc.

FOMU YA MAOMBI YA MWANACHAMA

Asante kwa shauku yako katika Mtandao wa Tiba ya Muziki Weusi, Inc. Kuwa mwanachama papo hapo hutoa fursa za kuimarisha uhusiano na watu kwenye makutano ya muziki na afya ndani ya jumuiya za Weusi. Vituo vya uanachama hujumuisha watu wa asili ya Kiafrika au waliowekwa kwa rangi kama Weusi. Kujiunga ni rahisi! Jaza fomu ya maombi ya mwanachama hapa chini, chagua mpango wako, na ujiunge leo!

Jina la kwanza

Jina la familia

Barua pepe

Jina Linalopendekezwa

Viwakilishi

Mashirika/Mahusiano

Anuani ya mtaa

Mstari wa 2 wa Anwani ya Mtaa

Jiji

Mkoa/Jimbo/Mkoa

Msimbo wa posta / eneo

Simu

Tafadhali shiriki vitambulisho vyovyote vya kijamii ambavyo ni muhimu kwako na ambavyo ungependa tujue.

Tier 1

$500

Two Black student meet-ups provided annually (virtual only at this time)

Access to Syllabi Library and/or culturally responsive resources

Tier 2

$1000

Tier 1

Annual VIRTUAL anti-oppressive practice workshop (2 hour) facilitated by BMTN Staff or partners

Tier 3

$2000

Tier 2

Annual IN PERSON anti-oppressive practice workshop facilitated by BMTN Staff or partners

Tier 3

$2000

Two Black student meet-ups provided annually (virtual only at this time)

Access to library of Syllabi and/or other resources

Annual IN PERSON anti-oppressive practice workshop facilitated by BMTN Staff or partners

Select a Sponsorship Tier

University Sponsor: Tier 1 - $500

University Sponsor: Tier 2 - $1000

University Sponsor: Tier 3 - $2000

University Sponsor: Tier 4 - $4000

Ikiwa kuna maelezo yoyote ya ziada ambayo ungependa tufahamu, tafadhali shiriki hapa:

Je, unataka kuorodheshwa katika orodha yetu ya watendaji wa umma? Ikiwa ndivyo, tafadhali weka jina lako, kitambulisho chochote, huduma zinazotolewa, na maelezo ya mawasiliano kama ungependa yaonekane kwenye tovuti (km, John Joseph, MA, MT-BC, LPC; warsha za elimu kuhusu hip-hop nchini K. -12 Madarasa; johnjoseph@resist.org).

Kwa kuwasilisha fomu hii, ninathibitisha kwamba:

Mimi ni mtu wa asili ya Kiafrika na/au kwa rangi kama Mweusi.

Ninathibitisha dhamira ya BMTN kusaidia afya na ustawi wa jumuiya za Weusi kupitia muziki.