2027 DREAM Ambassador Application
Dedicated, Responsible, Empowered, and Motivated
Name
*
First Name
Last Name
Birthday
*
-
Month
-
Day
Year
Date
Gender
*
Male
Female
Prefer not to specify
Other
Phone Number (Please list the youth's phone number, not social worker's. If youth does not have a cell phone put N/A)
*
Email (If you do not have one, put N/A)
*
Address (please list the address you CURRENTLY live at)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What county are you from?
*
Who is your social worker?
*
Are you currently in care?
*
Yes
No
If Yes, list the date you entered care. If no, list the date you exited care.
*
Please list your social worker's email address and phone number
*
Please list your placement and their phone number
*
Education (Please list what school you attend and what grade you are currently in)
Achievements
*
Describe your current involvement with your county
*
Please tell us why you want to become a DREAM Ambassador and what you would like to learn from this experience.
*
References
You MUST provide the name, email, and phone number for 3 references
Reference #1
*
Name, phone number, email address
Reference #2
Name, phone number, email address
Reference #3
Name, phone number, email address
Please upload a headshot (if you do not have a professional headshot, please upload an APPROPRIATE photo of yourself)
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*By signing, I certify that all of the information in this application is true and complete to the best of my knowledge. I understand that any false or incomplete answers may disqualify my consideration for this program.
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