Service providers form – My Brotha's Keeper International

My Brotha's Keeper International

IT IS IMPERATIVE FOR ALL BLACK MEN TO INVEST IN THEIR WELLNESS

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About
- Meet the team
- Testimonials
Sesa Wo Suban Membership
Events
- Past Events
Store
Contact
Log In

SESA WO SUBAN SERVICE PROVIDERS

STEP 1

CLICK HERE FOR FACILITATORS REGISTRATION FORM

STEP 2

CLICK HERE FOR SERVICE PROVIDERS ASSESSMENT FORM

STEP 3

CLICK HERE FOR SERVICE PROVIDERS DIRECTORY AND STORE SUBMISSIONS FORM

STEP 4

CLICK HERE TO REGISTER AS A STORE VENDOR

FACILITATORS REGISTRATION FORM

First Name:

Last Name:

Phone Number:

Email:

Social Media:

Address:

Zip code/Postal code:

Country:

Upload references and certifications:

Upload a profile picture (As clear as possible):

SERVICE PROVIDERS ASSESSMENT FORM

My Brotha’s Keeper International (MBK) Service Provider Screening and Vetting Questions:
When a king has good counselors, his reign is peaceful – (Ashanti proverbs)
Dr. Amos Wilson admonishes us to Afrakanize everything in the interest of decolonizing ourselves. To Afrakanize everything means to decolonize everything.

Please answer all questions as honestly as possible:

1. Are you Male or Female?

Male Female

2. Are you a Afrakan-centered service provider?

Yes No

3. Are you a registered/certified/licensed

Coach/teacher Counsellor/therapist Workshop facilitator

Other please specify).......

4. How does your product or services benefit Black men?

5. What does being Afrakan-centered mean to you?

A key component of Black men healing is for them to recognise their value as being complementarity to the Black woman. Baba Mwalimu K. Omani Buruti focuses on this work, which includes building a shared mission, knowing who your common enemy is, and knowing the difference between raising v.s. rearing an Afrakan child.

6. Does your product or service promote or advocate complementarity relationships between Black men and Black women?

Yes No

7. Are you licensed, registered or certified to sell the products and/or services you provide?

Yes No

8. Does your product or service promote and advocate decolonization via cultural, psychological and economic freedom?

Yes No

9. How many years have you been practicing in your chosen field?

1-5 Years 5 -10 Years 10 or more

10. Which best describes your work ethic and character?

My word is bond: I do what I say I'm going to do I have a tendency to over-extend myself I have difficulties with time-management and letting others know I can't commit. I really want to help and struggle with making commitments

11. Before you go ahead filling out the rest of this form will this be a conflict of interest with your line of work?

Yes No

SERVICE PROVIDERS DIRECTORY SUBMISSIONS FORM

To be added to our online business directory and store please fill out the form with your details below:

Company Name:

Discription of your business and services:

Phone No.

Email:

Website:

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STEP 1

STEP 2

STEP 3

STEP 4

FACILITATORS REGISTRATION FORM

SERVICE PROVIDERS ASSESSMENT FORM

SERVICE PROVIDERS DIRECTORY SUBMISSIONS FORM

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