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Please read carefully before signing. If you have any questions or concerns regarding the following agreement, please contact StartingIntoPractice@ncmic.com or 515-313-4727.
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.