Pro-Voice Ambassador Application
Email address *
First Name *
Your answer
Last Name *
Your answer
Address *
Your answer
Phone Number *
Your answer
What are your key identities? *
Your answer
How did you learn about Exhale? *
Your answer
What does “pro-voice” mean to you? *
Your answer
Why do you want to be a pro-voice ambassador with Exhale? *
Your answer
What are you excited about in becoming a pro-voice ambassador? *
Your answer
What are you concerned about in becoming a pro-voice ambassador? *
Your answer
Describe a difficult conversation you've had where there was clear conflict/disagreement. How did you feel about it when it was happening? How did you handle it? What would you have done differently? How do you feel about it now? *
Your answer
What networks are you connected to that you would like to share a pro-voice conversation on abortion, and why? *
Your answer
Do you have a close friend/colleague you could partner with on this project? If so, who are you thinking of and why? *
Your answer
Tell us about your experience leading or facilitating groups. *
Your answer
What special skills will you bring to your pro-voice ambassador role? *
Your answer
How are you hoping to contribute to or expand Exhale's mission? *
Your answer
Can you commit to doing 4 virtual training sessions (2 hours/each) with Exhale staff? *
How soon can you start the training with us? *
Your answer
What are the best times for you to participate in training? *
Check one time zone, and as many other options that apply
Required
Who are two people who have been mentors to you? What do you appreciate about them? What have you learned from them? *
Your answer
Describe your community of support. Who do you rely on? What kind of support do you think you will need during this project? *
Your answer
If accepted into the pro-voice ambassadors program, I agree to participate to the best of my ability by attending virtual trainings, participating in conversations with other trainers and staff, following through on periodic check-ins and do outside work as assigned. (space for e-signature) *
Your answer
Personal and Professional References
No family members, please
Reference 1
Name *
Your answer
Relationship *
Your answer
Email *
Your answer
Phone Number *
Your answer
Reference 2
Name *
Your answer
Relationship *
Your answer
Email *
Your answer
Phone Number *
Your answer
Reference 3
Name *
Your answer
Relationship *
Your answer
Email *
Your answer
Phone Number *
Your answer
Additional Comments *
Your answer
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google.