Ambassador Application

All fields marked with * are required.

Starting Into Practice Student Ambassador Application

First Name: *

Last Name: *

Mailing Address: *

Apt., Ste., P.O. Box

City: *

State: *

ZIP: *

Phone: *

Preferred Email: *

Permanent Email *

Birth Date *

School *

Expected Graduation Date: *

Social Media

Are you on social media? *

Yes - Please provide your handles below.
No

Instagram

LinkedIn:

Professional References

Professional Reference 1 Name: *

Reference 1 Email: *

Phone: *

Professional Reference 2 Name *

Reference 2 Email: *

Reference 2 Phone: *

Essay Section

What inspired you to apply for the ambassador role? *

What excites you most about the opportunity to serve as an ambassador? *

What strengths or experiences do you bring that would make you a great fit for this role? *

What do you hope to gain or learn through your experience as an ambassador? *

Share an experience where you took the initiative to guide others toward a goal. *

Are You an Ambassador for Another Company?

If Yes, please provide the name of the company you represent.

Signature

Please read carefully before signing. If you have any questions or concerns regarding the following agreement, please contact StartingIntoPractice@ncmic.com or 515-313-4553.

I hereby certify that I am eligible to work in the United States with a valid social security number. I acknowledge that, if selected, I am responsible for all taxes as an independent contractor.

The information given in this application is correct to the best of my knowledge. I understand that the information will be used for consideration for a position in the NCMIC Starting Into Practice Ambassador Program. I understand and agree that the decision made regarding my application by the selection committee will be final.

Electronic Signature: *

Date: *

Ambassador Application

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We are accepting applications from the following schools: