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Ambassador Form
Application for Neighborhood Ambassador: Please complete by Dec 15th for full considerations
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First & Last Name
Your answer
What neighborhood do you live in?
Your answer
Tell us how long (in years) you have lived in your neighborhood.
Your answer
What is your email?
Your answer
What is your phone number?
Your answer
Are you comfortable with smartphones/tablets and computer technology?
Yes
No
Clear selection
Do you have reliable internet access via smartphone, tablet, or computer?
Yes
No
Clear selection
Choose your employment status...
Full-time
Part-time
Self-employed
Retired
Unemployed
Clear selection
Will you be able to attend monthly meetings regularly? 6:00 p.m. on first Thursdays of the month (virtually/in-person). If not, please add what time and day works best for you.
Yes
No
Other:
Clear selection
Are you comfortable with talking to individuals and in group settings?
Yes
No
Other:
Clear selection
Are you comfortable starting conversations with your neighbors who may or may not know about this organization and mission?
Yes
No
Other:
Clear selection
Are you comfortable contacting your neighbors and bringing them to the meetings?
Yes
No
Other:
Clear selection
Do you have experience with volunteering for activities in your neighborhood and at other events?
Yes
No
Other:
Clear selection
Are you interested in joining CERT (Community Emergency Response Team)
Yes
No
Clear selection
If you are interested in joining CERT, a background check is required. Are you confident that you will pass a level II background check?
Yes
No
Unsure
Not interested in joining CERT
Clear selection
How did you hear about this program?
Your answer
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