Women Ambassador Application
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First and Last Name *
Mailing Address *
Birthday *
MM
/
DD
/
YYYY
Best Email *
Best Phone Number *
Have you ever been involved in a political campaign? *
If you have been involved in a political campaign in the past, what did you do?
In your opinion, what are the things happening politically that have the greatest impact on your life? *
Do you feel you can do something to improve this? *
How well do you feel you are represented in government? *
Not represented at all
Represented extremely well
What level of politics do you feel would have the greatest impact on your life? *
How important is political party to you?  (i.e. democrate, repulican, independent) *
Not important at all
Very Important
How much time do you have to work as an ambassador? *
Which best describes you?
Clear selection
Would you be willing to post political content on your social media accounts? *
The majority of this work will take place between June 1 and November 5th.  Can you commit to the entire program?  
Clear selection
If you can not commit to the entire 5 months, which months are you available to assist us?  Check all that apply *
Required
Why do you want to be an ambassador in the Women's Ambassadors for Change? *
Would you be interested in a leadership role?  If so, which areas interest you?  
Is there anything else you'd like us to know about you?
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