AFFIRM Ambassador Application

AFFIRM Ambassador Application

How did you hear about AFFIRM?

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

Date

My Pronouns Are:

Racial Identity

Gender Identity

Emergency Contact Name

Emergency Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Parent/Guardian Name

Required if applicant is under 18

Parent/Guardian Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Are you available to attend the in-person AFFIRM leadership summit at Georgetown University?

School & Experience

Current School, College, or Employer

Major or Field of Study (if applicable)

Tell us about any clubs, organizations, or extracurricular activities you're involved in.

Do you have prior experience serving on any councils, boards, or ambassador programs? If so, please describe.

What would you like to do after high school or college — what are your career or education goals?

Share any honors or awards you have received.

Do you have any public speaking experience? Such as participating on a panel, debate, etc. If yes, please use "Other" to describe.

Letter of Recommendation

Recommender Name

First NameLast Name

Recommender's Relationship to You

Recommender Email or Phone Number

Resume or Writing Sample (optional)

Personal Insight

Please write your own answers without AI. When everyone uses it, the responses start to sound the same — we want to know who you are, not a polished AI version of who you think we're looking for.

Can you share a moment that was significant to your journey or identity as an LGBTQIA+ individual?

Understanding of LGBTQIA+ Issues

How would you explain the importance of LGBTQIA+ representation — and of understanding intersectionality (how race, class, gender, and other identities overlap) — to someone unfamiliar with these topics?

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 you supported a friend, peer, or someone from a different background through a challenging situation — what did that teach you about empathy and respecting differences?

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?

If selected as an Ambassador, what kind of service project would you want to lead or contribute to — for example, mental health/wellness, digital safety, civic engagement, or LGBTQIA+ education and awareness?

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?

What's a current event, issue, or trend outside the LGBTQIA+ space that you follow closely or care about — and why does it matter to you?

Feedback and Growth

I certify that the information provided in this application is accurate and complete.

Describe a time you received difficult feedback or had to step outside your comfort zone to grow — how did you handle it, and what did you learn?

I understand that AFFIRM requires attending the in-person summit at Georgetown University and completing a service project, and I commit to fulfilling these requirements if selected.

Personal Information