ASCP Ambassador Application

Institution/Employer Information
Institution/Employer Name*
Your Role*
Location*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Volunteer History
Please list your previous ASCP volunteer committee positions, if applicable:
Please indicate if you are, or have been, involved in any of the following ASCP programs:

ASCP 40 Under Forty RecipientASCP Award RecipientASCP Education Faculty SpeakerASCP Local ChapterASCP Mentorship Program (Mentor)ASCP Mentorship Program (Mentee)ASCP Poster PresenterASCP Scholarship RecipientASCP Lab Stewardship (formerly Choosing Wisely) Champion Program
Please indicate which year you received your 40 Under Forty Recipient status:
Please indicate which ASCP award(s) you have received:
Please indicate which live learning sessions you were a faculty speaker at:
examples: AM (use for Annual Meeting) 2025, KL (us for KnowledgeLab) 2025, PU (use for PathUpdate) 2025, etc.
Please indicate which ASCP Local Chapter you are a part of:
Please indicate which year you presented your poster at an ASCP Annual Meeting:
Please indicate which ASCP scholarship(s) you have recieved:
Please list any other relevant external volunteer positions (past/current), if applicable:

Final Steps
List here any potential conflicts of interest that may interact with your contributions to the ASCP volunteer program:*
If there are none, please submit "N/A".
For more information regarding what ASCP constitutes as a conflict of interest, please click here.
Upload your Curriculum Vitae (CV) or resume here:*

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To the best of my knowledge, the information provided in this application is accurate. *

Please add your signature to attest to this statement.
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