Student Ambassador Application

Student Ambassador Application Instructions
Letter of Recommendation Form (use this form to upload all recommendations)

Applicant Information

First
Last
Primary Phone
Alternative Phone (optional)
Current Address/Residence
Primary Email

Employment Information

Education Information

First
Last
Program Coordinator Email
Program Coordinator or Department Phone

References

List two references, other than family or clergy, along with their contact information.
NOTE: One must be a HIM faculty member in the program which you are currently enrolled.
First, Last
Primary Email
Primary Phone
First, Last
Primary Email
Primary Phone
Drop a file here or click to upload Choose File
Maximum upload size: 2.1MB
Please upload a copy of your official or unofficial college transcripts (PDF Format Only).