2024 Ambassador Application
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
LinkedIn Profile
Personal Email Address - not associated with your school
*
example@example.com
Parent or Guardian Name
*
First Name
Last Name
Parent or Guardian Email Address
*
example@example.com
Which race best describes you?
Asian /Pacific Islander
African American/Black
Hispanic/Latino(a)
Native American / Native Hawaiian / Alaska Native
Multi-Racial
I prefer not to respond
School Name
*
School City and State
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Class during 2024-2025
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Please Select
Freshman
Sophomore
Junior
YWIB chapter closest to your residence.
*
Please Select
Capital Region
Chicago
Connecticut
Greater Boston
Greater Montreal
Metro New York
Philadelphia Metro
Pittsburgh
RTP
San Francisco Bay Area
Seattle
Southern California
National Chapter
Other
In 200 words or less, what interests you most about STEM?
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Interest: In 200 words or less, what STEM programs, activities, or events would you like to create to promote the YWIB mission?
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Please describe your most recent STEM activities.
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What skills have you developed that you believe will be most important as a YWIB Ambassador?
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Resume: Please include your current resume that lists your involvement in student and community organizations, your experiences with STEM, and/or leadership experiences.
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Reference: Please upload a reference completed by someone other than parent or guardian on your school's letterhead.
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Photo: Please upload a front-facing headshot with a neutral background.
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Permission to Participate: I, Parent/Guardian, hereby consent that the minor is able to apply and participate in the Young Women In Bio (YWIB) program and corresponding YWIB online or in person* activities. I understand and allow that any information provided, including information related to her participation in online or in person* YWIB activities, including photographs, motion picture or videotape taken during her participation in YWIB related events for which s/he posed, and/or audio recordings made of her/his voice, and/or quotations of statements s/he made may be used by Women In Bio and its assignees or successors, in whatever way they desire, including television and electronic media. Furthermore, I hereby consent that such photographs, films, recordings, plates, and tapes are the property of Women In Bio, and they shall have the right to sell, duplicate, reproduce, and make other uses of such photographs, films, recordings, plates, and tapes as they may desire free and clear of any claim whatsoever on my part. I give permission for my child to participate in YWIB programs.
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Application Checklist
*
Application completed
Resume uploaded
Reference uploaded
Current headshot uploaded
Parent/Guardian consent form signed
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