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Victims' Rights Ambassador (ViRA) Program Application
Thank you for your interest in joining the Ambassador Program with the Ohio Crime Victim Justice Center. Please answer the following questions. The board president and/or OCVJC Staff will contact you after viewing your application.
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First Name *
Last Name *
Preferred Pronouns
Phone Number *
Email Address *
Emergency Contact Name *
Emergency Contact Number *
Social Media Handles (FB, Twitter, Instagram, LinkedIn, SnapChat, etc.)
What College / University do you attend? *
Major / Program of Study
Anticipated Graduation Date
MM
/
DD
/
YYYY
How did you hear about the Ambassador Program? *
Do you belong to other student organizations? If so, please list below.
Relevant skills that may be beneficial to Ambassador Program:
What attracted you to the Ambassador Program?
Are you interested in becoming an Ambassador Board Member?
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Are you willing to complete a background check? *
Are you willing to sign a confidentiality agreement, whereby you agree to keep all client information, and any other information deemed private, confidential (not shared with others in any manner)? *
I consent to allow the members of the Ambassador Program to have access to the information within this form: *
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