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Student Ambassadors Application
Contact Information
Name
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First Name
Last Name
Email
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Verify Email
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Address
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Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Phone
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School Information
Name of School
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Is this school accredited?
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Yes
No
Degree Pursuing
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Anticipated graduation date? [day/month/4 digit year]
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Applicant Information
Please provide a synopsis of why you are interested in participating in the Student Ambassador program.
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How will this opportunity help you to increase your contributions to your school and/or community?
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Application requirements include one recommendation letter from a faculty or staff member. [Required]
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The recommendation will be forwarded to info@formidwifery.org with FSA Program in the subject.
Will you be requesting student credit from your school?
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If Yes, you are responsible for submitting the proper paper work to FAM with your application so that it can be reviewed prior to your acceptance into the program. Forward to info@formidwifery with FSA Program in the subject.
No
By signing this you acknowledge that all of the information provided is accurate.
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