AFFIRM Ambassador Application

AFFIRM Ambassador Application
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Name*

First NameLast Name
Preferred Name *
Personal Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone*
Format: (000) 000-0000.
Date of Birth*
Format: (000) 000-0000.
He/Him/HisShe/Her/HersThey/Them/TheirsZie/Zim/Zis
European/CaucasianPacific IslanderBlack/African-AmericanNative AmericanCaribbeanEast AsianCentral AsianSouth AsianSoutheast AsianWest AsianMENA (Middle Eastern/North African)HIspanic
European/CaucasianPacific IslanderBlack/African-AmericanNative AmericanCaribbeanEast AsianCentral AsianSouth AsianSoutheast AsianWest AsianMENA (Middle Eastern/North African)HIspanic
Emergency Contact: Full name and cell phone*
Experience
Name of High School*
Share about any clubs or organizations you belong to.*
Extracurricular activities.*
Share any honors or awards you have received.
YesNo
Personal Insight
Can you share a moment that was significant to your journey or identity as an LGBTQIA+ individual?
Understanding of LGBTQIA+ Issues
How would you describe the importance of LGBTQIA+ representation in media, education, and communities to someone unfamiliar with the topic?
In your opinion, what are some of the biggest challenges facing the LGBTQIA+ community today, and how have they impacted you personally or people you know?
Community and Support
Describe a time when you supported a friend or peer through a challenging situation. What did you learn from that experience about empathy and assistance?
How do you envision contributing to a supportive and inclusive environment within the AFFIRM program?
Expectations and Goals
What motivates you to apply for the AFFIRM program, and what do you hope to gain from your participation?
Can you share a goal or dream you have that being a part of AFFIRM might help you achieve?
Advocacy and Leadership
Describe any past experiences you have with leadership or advocacy, especially related to LGBTQIA+ issues. How do you hope to build on these experiences through AFFIRM?
How do you feel about working in teams to address issues related to bullying, violence, and suicide prevention among LGBTQIA+ youth?
Cultural Competence
In what ways do you think understanding intersectionality (the interconnected nature of social categorizations such as race, class, and gender) is important for LGBTQIA+ advocacy?
Can you give an example of how you've respected cultural differences in a community or group setting?
Feedback and Growth
How do you handle receiving feedback, especially in areas related to personal growth and development?
Can you share an instance where you had to step out of your comfort zone to learn or experience something new? How did it impact you?
Should be Empty: