Student Ambassador Application Form

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Please read and follow the instructions carefully. Required responses are noted with a * symobl.

All correspondence will be generated from the information submitted below. Please use proper spelling, capitalization, and punctuation.

The Alliance Building and Training Session (ABTS) is an exciting learning event for Bridge to Employment (BTE) sites from around the world. Johnson & Johnson & FHI 360 are seeking highly motivated Student Ambassadors to represent their BTE sites at the 2013 ABTS.

Student Ambassadors will share information about their experiences in local BTE programs, work with Student Ambassadors from different BTE sites, and bring their learning from ABTS back to their local BTE program.

Qualified applicants will have:
-Strong communication, public speaking, and organizational skills
-Eagerness to learn
-Ability to work with business leaders, educators, and fellow students
-Knowledge of their local BTE program, preferably at least one year of experience
-Creativity
-Desire to share information learned at the ABTS with BTE peers
-Knowledge of or willingness to learn PowerPoint

Students from the following sites are eligible to apply: Ambler, Pennsylvania; Cape Town, South Africa; Johannesburg, South Africa; Leiden, Netherlands; Panama City, Panama; Prague, Czech Republic; and Wilmington, Delaware. Students who attended a previous ABTS are not eligible to apply.

Candidates must be available to travel to Leiden, The Netherlands from October 13 through 16, 2013 with a local chaperone. ABTS offers an excellent benefit package including paid hotel, airfare, meal expenses, and student-only sessions.

Top candidates from each site with be asked to conduct a brief video or telephone interview with committee representatives prior to final selection of Student Ambassadors during the weeks of March 25- April 5, 2013. Final Selections will be made by April 15, 2013.

Qualified students should submit their resume and application form online by Friday, March 8, 2013.

Late applications will not be accepted.

Full Legal Name*

PrefixFirst NameMiddle NameLast NameSuffix

Nickname

Birthdate:*

MonthDayYear

School Name*

School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Home Address :*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone number (home or mobile):*

Alternate phone number:

E-mail address where you can be reached:*

Where the confirmation will be sent

Gender:*

MaleFemale

Do you have a passport?*

YesNo

Do you have experience with PowerPoint?*

YesNo

What language(s) do you speak? Please list all languages spoken.*

Applicant's BTE site (check one):*

How has BTE impacted your goals for higher education and career? How do you plan to use what you've learned in BTE to achieve your goals?*

Why are you interested in attending ABTS? What do you hope to gain from your experience at ABTS?*

Part of your role as a Student Ambassador will be to represent your country and your BTE site. How will you serve as an effective and diplomatic ambassador for your BTE site?*

Upload your resume or CV (PDF or Word document accepted):*

If selected I agree to travel with and follow the instructions of a chaperone from my local BTE site:*

Yes

By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.

E-Signature:*

If you have trouble entering information or submitting the online application please contact Caitlin Rose Dailey at cdailey@fhi360.org or 202-884-8140.

Bridge to Employment Student Ambassador Application

I. Personal Data:

II. Short-answer Questions:

VIII. Applicant's E-Signature