NXGN Campus Ambassador Network
Application Form
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
School Name
Course of Study
Level
Are you involved in any student or social organizations on campus or served as a Campus Ambassador for other Organization?
Yes
No
Will you be able to refer a minimum of 5 clients monthly ?
Yes
No
Not sure
If considered for this position, confirm your availability to attend online ambassador training sessions and actively participate in program activities?
Available
Not Available
Submit
Should be Empty: