Student Ambassador Application

Application Deadline: 11:59 p.m. CST, August 9, 2019

All fields marked with * are required.

Starting Into Practice Student Ambassador Application

Social Media

Professional References

Essay Section

Signature

Please read carefully before signing. If you have any questions or concerns regarding the following agreement, please contact StartingIntoPractice@ncmic.com or 515-313-4538.

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.