Page 1 of 1
Civic Health Ambassador Application
Note: This form is currently closed. For opportunities to get involved, visit vot-er.org/careers
First Name
*
Last Name
*
Email
*
Phone number
*
Pronouns
*
Pick one or more pronouns, or select 'Custom' to write your own
Pronouns
A
he/him
B
she/her
C
they/them
D
Custom
What kind of pre-health student are you?
*
Which college/university do you attend?
*
What year are you?
*
What year are you?
A
First year
B
Second year
C
Third year
D
Fourth year
Do you identify with any of the following groups?
Do you identify with any of the following groups?
First-generation college student
First-generation American
Bilingual/multilingual
People with disabilities
What organizations/communities are you a part of on campus?
*
In 4-5 sentences, describe a specific skill or personal attribute which will help you build our Vot-ER movement.
*
What excites you most about being a Civic Health Ambassador
*
Select up to three options, or write your own. There are no wrong answers! đ
What excites you most about being a Civic Health Ambassador
To learn from experienced community organizers
To make an impact in my community
To learn leadership skills
To help my patients, friends, and/or family register to vote
To connect with my classmates
To learn more about the relationship between voting and health as part of my pre-health training
Other (Write in)
Submit