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:

Lucas Brown
brown_l@iowacentral.edu
515-574-1007

* 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 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.

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?
	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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