NATIONAL JUNETEENTH AMBASSADOR INITIATIVE APPLICATION

NATIONAL JUNETEENTH AMBASSADOR INITIATIVE APPLICATION
Official Application Form
Applicant's Full Name
Applicant's Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What school do you attend and what grade are you in?
How old are you?
When is your birthdate? (Use Month Day Year format: June 9, 2022)

MonthDayYear
Date
What are your hobbies and interests?
Please list ALL social media accounts: (Facebook, Instagram, Tik Tok, etc NOTE: Failure to disclose this information may result in disqualification from selection).
Why do you want to be apart of the National Juneteenth Ambassador Initiative?
PARENT/GUARDIAN INFORMATION & PERMISSION AUTHORIZATION
Name
Address
Phone
Emergency#
Email_
example@example.com
I agree that all information provided above is accurate. Any misrepresentation of the truth will cause immediate disqualifications from selection. I understand the rules and regulations and hereby give permission for my child to apply to the NATIONAL JUNETEENTH AMBASSADOR INITIATIVE. I further acknowledge the mandatory meetings/workshop, rehearsal dates, and give consent for exclusive media use, (such as photos and videos captured), by the organization.
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

PARENT/GUARDIAN INFORMATION & PERMISSION AUTHORIZATION