African American
Mutual Assistance Network, Inc.
A.A.M.A.N.

Adding Links To Your Community's Chain Of Prosperity!

Next Step Program Application
· First Session begins on Wednesday, March 17, 2010 and ends on Wednesday, May 19, 2010.
· Second Session begins on Wednesday, May 26, 2010 and ends on Wednesday, July 28, 2010.
· Third Session begins on Wednesday, August 4, 2010 and ends on Wednesday,October 6, 2010.
E-mail Address: *
What Session you are Attending? *
Are you committed to full 10-week Session? *
There is a Maximum of two Excused Absentees. Do you Agree to this Rule? *
Do you qualify as a Minority, At-Risk Youth or Talented Student? *
Todays Date: *
Your Full Name: *
Street Address: *
City: *
State: *
Your Age: *
Your Gender: *
Your Ethnicity: *
Other
Your Date of Birth: *
Year in School: *
School you are Attending: *
Your GPA: *
Who do you live with? *
Other
Are you Employed? *
If Yes, who is your Employer?
What are your Hobbies? *
Do you have any Medical Conditions? *
If Yes, Explain:
Will you need to be Picked-up and Dropped-off? *
Your Area Code and Phone Number: *
Why do you want to attend the Program? *
Please Post any Comments you may have:
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Cecil Adams, Jr., CEO and Founder, AAMAN  •  Valjean J. Adams, COO and Co-Founder, AAMAN
2709 South Avenue, Suite E, Wisconsin 54601  •  955 Hwy. 61 E. Suite 123, Winona, Minnesota 55987
Email aaman@aaman.us  •  Telephone 608-779-0676 •  507-313-8960 •  Website http://aaman.us