ELITE Ambassadors Council (EAC) Application

PARENT'S INFORMATION

(COMPLETE IF YOUR CHILD IS UNDER 18)
Parent/Guardian's Name (Required if you are under age 18)

PrefixFirst NameMiddle NameLast Name
Parent/Guardian's Email (Required if you are under age 18)
example@example.com
Parent/Guardian's Phone Number (Required if you are under age 18)
Please enter a valid phone number.
Are you employed (for Student)

YesNo
If yes, where are you employed?

PARTICIPANT'S INFORMATION
Tell us about yourself:
List Your Hobbies.*
Which Social Media pages do you have? (Check all that apply:*

InstagramFacebookYouTubeBlogTiktokMy SpacePinterestNone of the aboveOther
Tell us something special about you!*
EXPLAIN in a short narrative response: What is 1 personal quality, skill, or talent you have that could help strengthen our efforts to promote healthy relationships (Ex: Hardworking, creative, leader, graphic designer, content creator, presenter and etc.)"*
EXPLAIN in a short narrative response: What is 1 personal quality, skill or talent you have that could help strengthen our efforts to prevent sexual assault and dating violence? (Ex: Hardworking, creative, leader, graphic designer, content creator, presenter and etc.)"*
Briefly, explain why you want to be an ELITE Ambassador.*

Signature & Agreement Page
As an Elite Ambassador Council (EAC) member, I agree to :*

Attend and participate in the EAC meetings.Coordinate educational activities and eventsSpeak out against dating violence and sexual assault.Remain violence free during the duration of this project.
Sign here to confirm that you agree to the above information
Signature* Date*
Finish
Thank you for your interest in joining

Our House, Inc.'s Elite Ambassador Council!

After completing this application,

and should you be selected,

we will notify you to arrange an interview.
Signature

Clear
This is a fill in the blanks field. Please add appropriate blank fields and text.
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PARENT'S INFORMATION