Tudor House Teen Ambassador Application Form

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Please see the full program description by clicking here.

Application Instructions:

1. Submit completed online application by September 14, 2026. Contact info@tudorhouse.net if you need to complete the application via mail.

2. References must be non-family members and not Tudor House staff/board.

3. Work can be saved and finished later. Just be sure to press save and enter your eMail.

4. Please add info@tudorhouse.net as an accepted email address. You will be contacted through email regarding further application requirements after you submit your application. People have missed important notifications because it went to spam.

5. Our meetings are usually on the fourth Sunday of every month from 4-6PM. Ambassadors cannot miss more than 2 meetings per year. Please keep this in mind before applying.

Thank you for your interest!
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Full Name* This field is required.
First Name
Middle Name
Last Name
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Gender Identity* This field is required.
Male
Female
Transgender
Non-binary
Gender Neutral
Prefer Not To Answer
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Birth Date* This field is required.
Month
Day
Year
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Ethnicity* This field is required.
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Mobile Number* This field is required.
Area Code
Phone Number
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E-mail* This field is required.Please use an email that is NOT your school email.
example@example.com
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Parent/Guardian E-mail* This field is required.
example@example.com
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Current Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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School name* This field is required.
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Current Grade
Please Select
Please Select
Freshman
Sophomore
Junior
Senior
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Current grade point average (GPA)
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Please fill in the extracurricular information for up to 5 activities you are consistently involved in (you are not required to list 5, only those that you choose).
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Extracurricular Activity 1: Please provide name of activity, description, and time commitment
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Extracurricular Activity 2: Please provide name of activity, description, and time commitment
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Extracurricular Activity 3: Please provide name of activity, description, and time commitment
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Extracurricular Activity 4: Please provide name of activity, description, and time commitment
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Extracurricular Activity 5: Please provide name of activity, description, and time commitment
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In 250 words or less, we ask you to briefly talk about your main idea and points, being concise and direct as well as explanatory.
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Explain why you want to participate in Tudor House Teen Ambassadors.* This field is required.
0/250
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How do you think you can help Tudor House reach teens with our mission of suicide prevention, education, and support?* This field is required.
0/250
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Tell us about something you are proud of or passionate about.* This field is required.
0/250
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What does mental health mean to you?* This field is required.
0/250
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Do you and your friends talk about mental health? If so, please elaborate on what those conversations are like.* This field is required.
0/250
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Teen Ambassadors will be expected to work together with other Ambassadors, be comfortable approaching and engaging other teens and adults, and be strong advocates for mental health and our Tudor House mission. What experiences have you had to prepare you for this? How comfortable are you in talking to new people?* This field is required.
0/250
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Please submit name, email, phone number and your relationship to 2 adults you have already asked to be a reference. These must be non-family members:* This field is required.E.g., Kathleen Thorell, info@tudorhouse.net, 540-761-6873, Youth Group Leader. Please contact and ask for permission prior to submitting their names.
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Is there any other information that you would like to share with us?
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Did you have any problem while filling out this form? If so, please report it below
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Do you agree that your parent/guardian is aware of your application, the time commitment required, and that they are willing to give permission for you to participate in Teen Ambassadors if selected?* This field is required.
Yes, I agree / Understand
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