Iowa Central Commuity College

Student Ambassador Application

Fill out the form below to apply for membership in Iowa Central's Student Ambassador program.

Questions about this application please reach out to:

Raeann Dischler

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Contact Information
* First Name: A value is required.
* Last Name: A value is required.
* Address: A value is required.
* City: A value is required.
* State: A value is required.
* Email: A value is required.Invalid format.
* Phone: A value is required.Invalid format.
* Date of Birth: A value is required.Invalid format.

Education Information
* Which Program/Major is of most interest to you? Please select an item.
* High School: A value is required.
* Cumulative GPA: A value is required.
* Graduation Year: A value is required.
* Semester Applying for: Please select an item.

  Are you bilingual? If so, please list the languages (other than English) that you are able to read/write/sign:
  List school, church, and community activities in which you have participated (list offices and leadership roles you have held):

List work/job experience (paid or unpaid):


List any honors, scholarships, or awards you have received:


Why did you choose to further your education at Iowa Central?


In your opinion, what are five factors that influence a student’s college decision:


List three personal qualities you possess that would enable you to be an effective Student Ambassador:

  Why do you want to be an Ambassador?
  Were you recommended by an Iowa Central staff member? If so, who?:
  Please list at least one reference (not related) we can contact if necessary:

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