Student 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: *

School Email: *

Alternate Email *

Birth Date *

School *

Expected Graduation Date: *

Social Media

Are you on social media? *

Yes - Please provide your handles below.
No

Twitter:

Facebook:

Instagram

LinkedIn:

Professional References

Professional Reference 1 Name: *

Reference 1 Email: *

Phone: *

Professional Reference 2 Name *

Reference 2 Email: *

Reference 2 Phone: *

Essay Section

How did you hear about this program? *

Why are you interested in becoming an NCMIC student ambassador? *

What qualities do you possess that would make you a good candidate to become an ambassador? *

What do you hope to acquire as an NCMIC Starting Into Practice ambassador? *

Give an example of a time you took a leadership role. *

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: *

Student Ambassador Application

We are accepting applications from the following schools:

Junior Ambassadors

Senior Ambassadors