If you use a different name from your legal first name, please provide it below.
Your answer
Last Name *
Your answer
Address Line 1 *
Your answer
Address Line 2
Your answer
City *
Your answer
State *
Zip code *
Your answer
Email Address *
Your answer
Confirm Email Address *
Your answer
Phone Number *
Your answer
Gender
Clear selection
School Information
Classes/courses taught *
Your answer
School Division *
If applying to be a college student ambassador, note the division of the high school that you graduated from.
Choose
Accomack County
Albemarle County
Alexandria
Alleghany County
Amelia County
Amherst County
Appomattox County
Arlington County
Augusta County
Bath County
Bedford County
Bland County
Botetourt County
Bristol
Brunswick County
Buchanan County
Buckingham County
Buena Vista
Campbell County
Caroline County
Carroll County
Charles City County
Charlotte County
Charlottesville
Chesapeake
Chesterfield County
Clarke County
Colonial Beach
Colonial Heights
Covington
Craig County
Culpeper County
Cumberland County
Danville
Dickenson County
Dinwiddie County
Emporia
Essex County
Fairfax
Fairfax County
Falls Church
Fauquier County
Floyd County
Fluvanna County
Franklin County
Frederick County
Fredericksburg
Galax
Giles County
Gloucester County
Goochland County
Grayson County
Greene County
Greensville County
Halifax County
Hampton
Hanover County
Harrisonburg
Henrico County
Henry County
Highland County
Hopewell
Isle of Wight County
James City County
King George County
King William County
King and Queen County
Lancaster County
Lee County
Lexington
Loudoun County
Louisa County
Lunenburg County
Lynchburg
Madison County
Manassas
Manassas Park
Martinsville
Mathews County
Mecklenburg County
Middlesex County
Montgomery County
Nelson County
New Kent County
Newport News
Norfolk
Northampton County
Northumberland County
Norton
Nottoway County
Orange County
Page County
Patrick County
Petersburg
Pittsylvania County
Poquoson
Powhatan County
Prince Edward County
Prince George County
Prince William County
Pulaski County
Radford
Rappahannock County
Richmond City
Richmond County
Roanoke City
Roanoke County
Rockbridge County
Rockingham County
Russell County
Salem
Scott County
Shenandoah County
Smyth County
Southampton County
Spotsylvania County
Stafford County
Staunton
Suffolk
Surry County
Sussex County
Tazewell County
Virginia Beach
Warren County
Washington County
Waynesboro
West Point
Westmoreland County
Williamsburg-James City County
Winchester
Wise County
Wythe County
York County
School Name *
If applying to be a college student ambassador, note the name of the high school that you graduated from.
Your answer
When is your school's spring break? *
Your answer
When is your school's prom?
If a tentative date has been published, please provide the date.
MM
/
DD
/
YYYY
When is your school's graduation or last day of school? *
MM
/
DD
/
YYYY
Social Media Information
What social media platforms do you use regularly? *
This information helps us plan our campaign messaging and plans to expand to other platforms.
Required
Which platform are you applying for?
You will be selected to complete tasks for only ONE platform. Indicate your preference below. Only check profiles that you want to be considered for.
Twitter
Facebook
First Choice
Second Choice
Twitter
Facebook
First Choice
Second Choice
What is your social media handle?
Provide the handle or URL for your profile in which you will be supporting the campaign. For Facebook, provide the URL to your profile page.
Your answer
What are your favorite social media accounts?
List your favorite social media accounts - these can be celebrities, influencers, brands, educational, sports, etc. - any in which you follow and check regularly!
Your answer
Social Media Ambassador Information & Short Answers
What impact do you want to have on improving traffic safety for youth?
Your answer
Tell us about your leadership interest and experience in your school and community.
Your answer
What are you passionate about? *
Your answer
How did you hear about the Choose Your Vibe - Arrive Alive! Educator Ambassador Program?