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Student Ambassador Request Form

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 * = Required Field
 
 * Activity Name:  
 
 * Description of Activity:
     
 
 * Date(s):    
 
 * Time(s):    
 
 * Activity Location:  
  (Examples: Student Cafeteria, Student Center Mounds, Botanical Garden, Ridgewood High School)   
 
  Off-Campus Location Address (include City, State and Zip Code)
 Off-Campus
Location Address
If applicable
   
 
 * Number of Ambassadors
 
                          

 
 * Ambassador Duties:
     
   
 * Activity Coordinator:  
 
 * Extension:   (Enter "0000" if no extension)
 
 * Email Address: