Fill - Free fillable Student Ambassador Application (Johnston Community College) PDF form

Student Ambassador Application

GENERAL INFORMATION:

Name: _______________________________________________________________________

Address: _____________________________________________________________________

City: _________________________ State: ________ Zip Code: ______________

County: ________________________ JCC Student ID Number: ____________________

Telephone Number: ___________________________________________________________

Cell Phone Number: _______________________________________________________

Email Address: _______________________________________________________________

EDUCATIONAL INFORMATION:

High School Name: ____________________________________________________________

City: _________________________ State: ________ Zip Code: ______________

Cumulative GPA in High School: ____________________

Please complete below information if currently enrolled at JCC or another college:

College Name: ________________________________________________________________

City: _________________________ State: ________ Zip Code: ______________

Cumulative GPA at JCC or other college: ____________________

Program of Study: ___________________________________

Cumulative Credit Hours (Johnston Community College students only): _______________

Anticipated Graduation or Transfer Date: ________________________________________

Updated - February 27, 2020

ANSWER EACH OF THE FOLLOWING QUESTIONS ON SEPARATE SHEETS OF

PAPER. EACH RESPONSE SHOULD BE NO MORE THAN 500 WORDS. PLEASE

INCLUDE YOUR FULL NAME ON THE TOP RIGHT CORNER OF EACH ESSAY.

1. Biography about yourself.

2. List ALL special awards, community service, talents, hobbies and interests.

3. Why did you decide on your program of study?

4. What are your plans after graduation?

5. Why would you be an effective Ambassador?

6. What one thing would you like the Ambassador Advisor to know about you? or

If you are a current Ambassador, why are you seeking to reapply to the program?

Please provide two letters of reference to accompany your application. Each letter must be

mailed directly to the JCC Foundation from the reference. (One professional and one

personal reference)

Applicant’s Signature __________________________________________________________

Date _________________________________________________________________________

COMPLETED APPLICATION, SIGNED CONTRACT, ESSAY QUESTIONS, AND

REFERENCES MUST BE SUBMITTED TO THE FOUNDATION OFFICE AT

JOHNSTON COMMUNITY COLLEGE BY FRIDAY, APRIL 10, 2020.

MAIL TO: JCC FOUNDATION

AMBASSADOR ADVISOR

JCC FOUNDATION OFFICE

P.O. BOX 2350

245 COLLEGE RD.

SMITHFIELD, NC 27577

LATE OR INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED.

Updated - February 27, 2020

Page 1 of 2

Student Ambassador Contract

If selected, I agree to meet the following expectations during my year as an Ambassador:

1. Participate in required functions and complete one service hour per week in Student

Services or Foundation offices (approximately 35 hours a semester)

2. Attend all requested

events and activities*

3. Attend scheduled meetings

4. Actively participate in Ambassador service project

5. Attend recruiting events and conduct tours of the campus

6. Participate in the Ambassador retreat and orientation training sessions

7. Forfeiture of any other JCC Foundation scholarship awarded through

johnstoncc.academicworks.com

8. If I withdraw from or am terminated from student ambassador duties prior to fulfilling

my year-long commitment, I may be required to repay my scholarship to JCC.

*Events and activities may occur at or with religious organizations and fall on weekends. Please

do not apply for this scholarship if you will be unable to fully participate in all functions.

If selected to represent Johnston Community College as a Student Ambassador, I will

receive:

1. Full tuition, activity and technology fees for one year FOR FALL AND SPRING

SEMESTERS ONLY (in-state tuition rate)

2. Personal and professional development

3. Clothing and name tag

4. Opportunities to meet community and state leaders and become acquainted with trustees,

foundation board, faculty, and staff

5. Membership of a small, exceptional group of students committed to the success of JCC

and its students

I understand that I will be excluded from further participation in the Ambassador

Program if any of the following conditions occur:

1. Seek nominations for/or become a SGA officer

2. Become enrolled for less than 12 semester hours with exception of the summer semester

3. Loss of good standing within the College or community

4. Cumulative grade point average drops below a 3.0

5. Failure to fulfill the standards of the program (including class and meeting attendance,

behavioral expectations, leadership class completion, minimum weekly service hours and

other mandatory functions)

Page 2 of 2

NOTE: Termination or withdrawal from the Ambassador program requires the return of all

items provided by Johnston Community College, and you may be required to repay the

ambassador scholarship to JCC. Failure to return Ambassador materials will result in a

hold placed on all grades released and future transcript requests.

In addition, by accepting this scholarship, the student agrees to forfeit any other JCC

Foundation scholarship awarded through johnstoncc.academicworks.com. (Outside or

third party scholarships may be retained.)

I, __________________________________________________, have read the above and

agree to fulfill these requirements if selected.

Date: _____________________________________

Student Ambassador Reference Form

(this form is supplemental to the reference letter)

Name of Applicant: ____________________________________________________________

Your Name: __________________________________________________________________

Relation to Applicant: _______________________________ Phone #___________________

This form is supplemental to the reference letter. You may fill out this form for the student who

has asked you to be a reference and enclose it with your letter in sealed envelope.

Please return letter of recommendation and this form to:

Advisor to Ambassadors

JCC Foundation

PO Box 2350

245 College Road

Smithfield, NC 27577

Please circle the number which best describes this student on each of the following

characteristics:

Excellent Good Average Poor N/A

ACADEMIC PERFORMANCE 1 2 3 4 5

LEADERSHIP 1 2 3 4 5

ATTENDANCE 1 2 3 4 5

RESPONSIBILITY 1 2 3 4 5

RESPECT SHOWN FOR OTHERS 1 2 3 4 5

PUNCTUALITY 1 2 3 4 5

WILLINGNESS TO TRY SOMETHING NEW 1 2 3 4 5

OVERALL ATTITUDE 1 2 3 4 5

Are there other factors that you feel might assist in determining whether this student

should be selected as a member of the 2020-2021 Johnston Community College Student

Ambassador Program?

______________________________________________________________________________

Signature: _________________________________ Date: __________________

Student Ambassador Reference Form

(this form is supplemental to the reference letter)

Name of Applicant: ____________________________________________________________

Your Name: __________________________________________________________________

Relation to Applicant: _______________________________ Phone #___________________

This form is supplemental to the reference letter. You may fill out this form for the student who

has asked you to be a reference and enclose it with your letter in sealed envelope.

Please return letter of recommendation and this form to:

Advisor to Ambassadors

JCC Foundation

PO Box 2350

245 College Road

Smithfield, NC 27577

Please circle the number which best describes this student on each of the following

characteristics:

Excellent Good Average Poor N/A

ACADEMIC PERFORMANCE 1 2 3 4 5

LEADERSHIP 1 2 3 4 5

ATTENDANCE 1 2 3 4 5

RESPONSIBILITY 1 2 3 4 5

RESPECT SHOWN FOR OTHERS 1 2 3 4 5

PUNCTUALITY 1 2 3 4 5

WILLINGNESS TO TRY SOMETHING NEW 1 2 3 4 5

OVERALL ATTITUDE 1 2 3 4 5

Are there other factors that you feel might assist in determining whether this student

should be selected as a member of the 2020-2021 Johnston Community College Student

Ambassador Program?

______________________________________________________________________________

Signature: _________________________________ Date: __________________

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Fillable Student Ambassador Application (Johnston Community College)

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