Student Civic Engagement Ambassador Program 
Welcome to the Maryland Office of the Secretary of State's Student Civic Engagement Ambassador Program. This is new program hosted through the Office for students in Maryland to be engaged within their community and the broader state.

This form is for students who are interested in our program and would like to participate. After you have responded to the questions below, someone will be in touch with you shortly for next steps.  Please fill out this form no later than March 7th, unless you have gotten permission for late consideration.

In the meantime, please reach out to the Community Liaison Coordinator, Miranda Parrish, at miranda.parrish@maryland.gov or Deputy Secretary of State, Michael Lore, at michael.lore@maryland.gov for any questions. 
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What is your name?
What local jurisdiction do you live in (county or Baltimore City)?
What high school do you currently attend?
What is your anticipated graduation year?
Where did you hear about our program?
What interests do you have that led you to our program and what insights do you hope to gain from your participation?
Please provide the best contact information for you and a guardian to sign off on a separate permission form (email and phone number).
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