Home
About
About IBE
Careers
IBE Chapters
Initiatives
State Small Business Credit Initiative
Black Business Training Institute
BBTI Central Indiana
BBTI Fort Wayne
BBTI Michiana
Economics
Education
FAFSA – College Coins
Health
Minority Small Business Series
Performing Arts Academy
Events
IBE Education Conference
IBE Business Conference
Summer Celebration
Circle City Classic
Support IBE
Become a Sponsor
Donate
License Plates
Volunteer
Contact
Instagram
Facebook
Twitter
YouTube
Home
About
About IBE
Careers
IBE Chapters
Initiatives
State Small Business Credit Initiative
Black Business Training Institute
BBTI Central Indiana
BBTI Fort Wayne
BBTI Michiana
Economics
Education
FAFSA – College Coins
Health
Minority Small Business Series
Performing Arts Academy
Events
IBE Education Conference
IBE Business Conference
Summer Celebration
Circle City Classic
Support IBE
Become a Sponsor
Donate
License Plates
Volunteer
Contact
DONATE
Register Now!
Please register using the form below.
Step
1
of
6
- Student Information
16%
Student Information
Name
*
First
Middle
Last
Which Class(es) Are You Interested In?
*
Please use the following to select which class(es) in which you are interested. You may select up to 2 classes.
Acting
Dance
Music Production
Photography
Video Production
STN:
8-digit school ID
Ethnicity
*
African-American
Caucasian
Hispanic
Native-American
Asian-American
Multi-Racial
Other
Gender
*
Male
Female
Gender Diverse / Transgender
Date of Birth
*
Month
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Current Age
*
If Other Please Specify
*
Student's Email Address
*
Enter Email
Confirm Email
Student's Cell Phone
Student's Home Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
T-Shirt Size
*
Choose Size
Extra Small
Small
Medium
Large
Extra Large
XXL
XXXL
XXXXL
XXXXXL
Twitter Account
TicTok Account
Instagram Account
Snapchat
Facebook
Student Employment Status
*
Not Employed
Employed Part-Time
Employed Full-Time
Name of Employer
*
Are you involved in extracurricular activities?
*
No
Yes
Please list your extracurricular activities.
*
Do you have any dietary restrictions?
*
No
Yes
Please list your dietary restrictions.
*
Are you a returning PAA student?
*
Yes
No
Parent/Guardian Information
Student lives with:
*
Both Parents
Mother Only
Father Only
Aunt/Uncle
Grandparents
Guardian
Other
If Other Please Specify
*
Parent or Guardian Name
*
First
Last
Please provide address:
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Parent/Guardian (1) Cell Phone
*
Parent/Guardian (2) Cell Phone
Parent/Guardian (1) Work Phone
Parent/Guardian (2) Work Phone
Parent/Guardian (1) Home Phone
Parent/Guardian (2) Home Phone
Parent/Guardian (1) Email
*
Enter Email
Confirm Email
Parent/Guardian (2) Email
Enter Email
Confirm Email
Educational Information
Is the applicant currently enrolled in school?
*
Yes
No
If no, please explain.
*
Current School:
*
Please provide a complete school name (no acronyms) i.e. Warren Central High School, not WCHS.
School Counselor's Name
First
Last
Counselor's Email
Current Grade:
*
High School Graduation Year:
*
21st Century Scholar
*
Yes
No
Program Information
Have you participated in any other IBE programs?
*
Yes
No
If yes, in which programs have you participated?
*
If this is your first IBE program, how did you hear about us?
*
Please check all that apply
IBE Event
Church
Community Event/Organization
PAA
Newspaper
Radio
School
Social Media
TV
Walk-In
Website
Other
If "other" please specify:
*
Confidential Information
The following information is
REQUIRED
for IBE to obtain funding as a Non-Profit Organization. Names are never used and the information is completely confidential. Your cooperation in providing this information is both appreciated and necessary.
Parent/guardian Employment Status:
*
Employed Full-Time (35 hours or more per week)
Employed Part-Time (Less than 35 hours per week)
Unemployed (seeking employment)
Not in the workforce (homemaker, disabled, or retired)
Other (entrepreneur or business owner)
Parents Education Level
*
Please indicate your highest level of education
High School Diploma or Equivilent
Associate Degree
Bachelors Degree
Advanced Degree (Master, Ph. D or Law)
Total number of individuals living in household:
*
Does the applicant receive Free or Reduced lunch?
*
Yes
No
Annual Household Income:
*
Check all programs that apply:
*
Please check all that apply
TANF
Food Stamps
Medicaid
SSI
SSDI
Veterans Compensation
Unemployment Compensation
None
Academic Records and General Release
*
Academic Records and General Release: I hereby give permission for my child, named above, to attend and participate in the IBE programs, activities and initiatives. For the purposes of marketing IBE programs, I hereby give permission for my child to be photographed and/or recorded. I also hereby give my permission for Indiana Black Expo, Inc., to secure copies of grades, attendance, discipline referral, suspension information, and school counselor’s reports from my child’s school. Student information collected by IBE from various vehicles is private and confidential. The data collected as well as the work product created is the sole property of IBE.
I agree to the terms of the Academid Records and General Release
Medical Release
*
Medical Release: I am the natural parent or legal guardian having custody of said child. In consideration of my child participating in IBE programs, I hereby voluntarily release and agree to hold harmless and indemnify IBE, each of its directors, officers, employees, volunteers and its partner organizations, or of said child. In the event that I cannot be reached in an emergency, I hereby give permission to the IBE staff/volunteer(s) to order x-rays, routine tests, treatment, to release any records necessary for insurance purposes and to provide or arrange necessary related transportation for my child. In the event I cannot be reached in an emergency, I hereby give permission to the physician or nurse selected by IBE staff/volunteer(s) to secure and administer treatment including hospitalization for the youth listed above. I do hereby agree to hold free from any and all liability all respective officers, employees and members. I hereby on behalf of my child waive, release and forever discharge any and all rights and claims for damages w
I agree to the terms of the Medical Release
Parent Signature
*
Phone
This field is for validation purposes and should be left unchanged.
Δ