Student Ambassador Application
APPLICANT INFORMATION______________________________________________________________
Name: ________________________________ Student ID #: _________________________
Address: ____________________________________________________________________________
City: _______________________________________ State: ___________ Zip Code: ________________
Preferred Phone: _______________________ E-mail Address: _________________________________
What languages other than English do you speak fluently? ____________________________________
EDUCATION RECORD__________________________________________________________________
Last High School Attended: ____________________________________ Year of Graduation: _________
If you have attended other colleges/universities, please list them below:
College/University
Location
Years Attended
Degree Attained
First Semester at FLC: _________________ Expected Graduation/Transfer Date: __________________
Units Completed at FLC: ___________ Cumulative G.P.A. at FLC: ___________
FLC Major & Educational Goal: ___________________________________________________________
EMPLOYMENT HISTORY AND REFERENCES_________________________________________________
Most Recent Employment: ______________________________ Job Type: _______________________
Please list two references.
Name
Organization/Company
Title
Phone #
QUESTIONS______________________________________________________________
Please type your answers to the questions below:
In a brief essay, state why you would like to serve as a Folsom Lake College Student Ambassador.
Include any qualities you possess that would qualify you to be a successful Student Ambassador.
What are your future plans and long-term career goals? How does being an Ambassador fit into these goals?
Please list any extra-curricular activities, clubs, and organizations that you are involved with.
College and High School Activities:
Community Involvement:
Hobbies:
How will you utilize your collegiate experiences to mentor Summer Bridge and First Year Experience
participants?
Consent for Verification of Student Records:
I hereby certify that all statements made on this application are true and correct to the best of my knowledge and authorize investigation
of all statements herein recorded. I release from all liability persons and organizations reporting information required by this application.
I grant permission to an authorized representative of Folsom Lake College to verify my student records for purpose of this application.
Signature: __________________________________________________ Date: ____________________