Ambassador Application (3) .pdf

2015-2016 Engineering Ambassador Application Form
General Information (Please fill out all categories)
Full Name

Major

Gender

Grade Level
Call / Text (Circle preferred form of contact)

Phone

Email

Number:_________________________

Email: ___________________________

Student ID
Are you a
Transfer?

Yes

No

Are you a
grad student?

Yes

No

Which of the following activities are you interested in? (Check all that apply)
Presentation:
Ambassadors will present about a STEM-related topic. Sometimes includes information about
college experiences through SJSU Engineering Programs, and general SJSU information.
(~30-45 minutes)

Hands-on Activity:
Ambassadors will lead a STEM-related activity, splitting students into groups of 4-5. Includes
opportunity for further discussion on the topic and Q&A after the activity.
(~30 minutes)

Student Panel:
Ambassadors will respond to questions regarding SJSU and their college experience.
(~30-45 minutes)

Tabling:
At elective/college night or career day events, Ambassadors are available to answer questions
regarding SJSU and College of Engineering Programs.

Virtual Meet & Greet:
Applies to schools more than 45 minutes away. Ambassadors will virtually meet and greet with
classrooms to answer questions, present and interact.

Mentor:
Ambassadors will mentor incoming Freshmen and Transfer students to help with the transition to
San Jose State University.

*EAP Classroom Connections:
1-2 Ambassadors will be assigned to a class. Will meet with class at least once per semester. Will
correspond with lead teacher of the class bi-monthly (by email) to provide updates of the projects
they are working on, give college advice and answer any questions the class has.

*Additional action required, see Code of Conduct Agreement section

What is your ethnicity or cultural background?

Caucasian
African American
Hispanic
Asian / Pacific Islander
Other Ethnicity: _______________
What size polo do you prefer? (Please circle)
Men:
Small
Medium
Large

X-Large

Women: Small

X-Large

Medium

Large

Would you be willing to use your car to help carpool events?
Yes
No
The questions that follow are optional and do not need to be answered. There is no right or wrong answers.

Have you served in another organization that performed outreach events?
Yes No
If yes, please indicate how many years you have worked with that organization:
____ Years
How many years have you served in the Engineering Ambassador Program?
0
1-2
3-4
4+
Where did you hear about EAP?
School Professor Counselor/Advisor
Friend Online
Other: __________________________
Have you participated in one of our Outreach Activities in Pre-College years?
Yes No
If so, do you have any comments about the activities or Ambassadors?

Code of Conduct Agreement
I understand I am a representative of the Engineering Ambassador Program, San Jose State
University, and the College of Engineering and will act accordingly. I agree to keep a
presentable appearance, have a professional demeanor and use professional language as
stated in the Code of Conduct. I understand I must be in good standing with the university and
my engineering major in order to remain an Engineering Ambassador. I have been given a copy
of the Code of Conduct and have read and understood them.

___________________________________
Print

___________________________________

______________

Sign

Date

*Optional

I would like to participate in Classroom Connections
What city do you prefer to travel to? __________________________
I agree to maintain the relationship with my assigned classroom for the entire semester. I
understand I must send the class bi-monthly email correspondences and have at least one
classroom visit per semester. I have been given a copy of the Classroom Connections
Guidelines and have read and understood them.

___________________________________
Print

___________________________________
Sign

______________
Date