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:

Shelby Illg
illg@iowacentral.edu
515-574-1008

* indicates a required field

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.
	Zip:
*	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 academic program are/will you be enrolled in? A value is required.
*	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.

Experience/Skills

	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? (Please answer the following questions in complete sentences)
	In your opinion, what are five factors that influence a student’s college decision: (Please answer the following questions in complete sentences)
	List three personal qualities you possess that would enable you to be an effective Student Ambassador: (Please answer the following questions in complete sentences)
	Why do you want to be an Ambassador? (Please answer the following questions in complete sentences)
	Were you recommended by an Iowa Central staff member? If so, who?: (Please answer the following questions in complete sentences)
	Please list at least one reference (not related) we can contact if necessary:

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