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Become an Exploritas Ambassador
 Thank you for your volunteer spirit and support of Exploritas. By sharing your Exploritas lifelong learning experiences, you offer older adults the opportunity to gain new knowledge and skills and interact with their communities and the world around them.

Please review the Ambassador Role before completing the following application.

 Title  First Name MI  Last Name

Address

 City  State  Zip/Postal Code

 Phone   Fax  Email Address
Please note: your email address will be used only to send you regular Exploritas updates, the ENews bulletin, and monthly Ambassador updates.

Exploritas Program Experience

 How many Exploritas Programs have you participated in? (3 + programs required)

Describe your best Exploritas program experience (in about 25 words).
 

If there was one thing you could change about your Exploritas experience, what would it be (in about 25 words)?
 

What is one of the most important characteristics of someone representing Exploritas
(in about 25 words)?
 


Tell Us About Yourself:

What is your proudest accomplishment (in about 50 words)?
 

List your affiliations and role with your local community organizations and/or interest groups and your role.
Affiliation Role (member, board member, director, etc.) Hrs / week Membership
Start Date 		Membership
End Date
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Others:
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Which region are you interested in becoming an Ambassador?
(List zip codes, area codes or county name)

Do you have adequate means of transportation to conduct your volunteer duties?
Yes No

How many miles are you willing to travel for a presentation?

Finally, how did you hear about the Ambassador Program?



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