Student Ambassador Application

Applications for the 2021-2022 school year are reopened for Rising Juniors, ONLY. We had an abundance of Seniors apply and would like to have more Juniors in our applicant pool. You will need your transcript, resume, & an the contact information for a reference. Incomplete applications will not be considered. Please apply by July 6.

LTBM Student Ambassador Program Rising Juniors 21-22

Step 1 of 5

About You, The Applicant
Name*
First Last
Phone*
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
What school do you attend?*
Are you a Rising Junior?*
- Yes! Rising Junior (c/o 2023)

Your Parents/Guardians and Emergency Contact
Parent's/Guardian's Name*
First Last
Parent's/Guardian's Phone*
Parent's/Guardian's Email*
Emergency Contact's Name*
First Last
Emergency Contact's Phone*

Recommendation
A recommendation is required as part of your LTBM Student Ambassador application process. The recommendation can be from a school administrator, counselor, teacher, coach, or employer. We will email the person you list below and supply them with a form to complete on your behalf. Please be sure to let them know that you have submitted their name for a recommendation.
Name of person to complete your recommendation.*
First Last
Email of person to complete your recommendation form*
How do you know this person?*

The Good Stuff
Why would you like to be a Student Ambassador for Let There Be Mom?*
Tell us in 250 words or less.
Please upload your resume.*
Please upload your transcript.*

Do you Agree?
By signing and submitting this application you are confirming that the information you included is accurate and true. And you agree, that if selected to represent your High School as a LTBM Student Ambassador for the 2021-2022 school year, you will be expected to attend the monthly meetings, as well as fulfill all other responsibilities outlined on the Student Ambassador Program Description while doing your best to represent LTBM in a manner consistent to the organization's image.
Signature*

Student Ambassador Application

LTBM Student Ambassador Program Rising Juniors 21-22

Step 1 of 5

About You, The Applicant

Your Parents/Guardians and Emergency Contact

Recommendation

The Good Stuff

Do you Agree?

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