Health Studies Student Ambassador Application

Health Studies Students will need to complete the application to be considered as a HLST Student Ambassador. Specify major concentration: HSMM, HSPP, or DLHS

Name: *

CWID: *

Email: *

Date: *

Month

Day

Year

Major: *

Grad Year: *

ACTIVITIES/ORGANIZATIONS

Please list activities/organizations you have been involved in. Briefly include information about your roles in the activity and what you gained through your participation.

GOALS

Describe your short- and long-term goals, professionally and personally.

APPLICANT QUALITIES

Why are you interested in becoming a HLST Student Ambassador?

By submitting this form, I certify that the information provided on this application is true and accurate.

CAPTCHA

This question is for testing whether you are a human visitor and to prevent automated spam submissions.

                  _____       _   _  __     __
   __ _  __   __ | ____|     | | (_) \ \   / /
  / _` | \ \ / / |  _|    _  | | | |  \ \ / / 
 | (_| |  \ V /  | |___  | |_| | | |   \ V /  
  \__, |   \_/   |_____|  \___/  |_|    \_/   
     |_|

Enter the code above *

Enter the code depicted in ASCII art style.

Brief interviews with Dr.D may be required. Students selected as HLST Student Ambassadors will be notified usually within one week.