Road Scholar Ambassador Online Application Thank you for your volunteer spirit and support of Road Scholar. By sharing your Road Scholar 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 Roles & Responsibilities before completing the following application. NONE MR MRS BR MISS MS DR PROF DEAN REV RAB MSGR SR FR LT CAPT COL MAJ SGT GEN ADM JUDG HON CMDR ENS LCDR RADM VADM  Title  First Name MI  Last Name Address Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated Micronesia Guam Marshall Islands Mariana Islands Northern Mariana Pacific Trust Territories Palau Puerto Rico Alberta British Columbia Manitoba New Brunswick New Foundland Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Northwest Territories Yukon  City  State  Zip/Postal Code  Phone   Fax  Email Address Please note: your email address will be used only to send you regular Road Scholar updates. Road Scholar Program Experience  How many Road Scholar Programs have you participated in? (5 + programs required) Describe your best Road Scholar program experience (in about 25 words).   If there was one thing you could change about your Road Scholar experience, what would it be (in about 25 words)?   What is one of the most important characteristics of someone representing Road Scholar (in about 25 words)?   Are you planning to enroll in a North American Road Scholar program within the next 12 months? If so, how many?   Are you planning to enroll in an International Road Scholar program within the next 12 months? If so, how many?   If you travel with other organizations, please list them and tell us what motivates you to travel with them.   Tell Us About Yourself: What is/was your primary occupation or profession?   What are your special interests or areas of expertise?   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 fsdgjnsg Others: Ambassador Program Expectations How many hours per week do you expect to commit to the Ambassador program? 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? Please briefly describe (in 100 words or less) your expectations for the Ambassador Program.   In order for the Ambassador Program to be beneficial to both Road Scholar and you, our Ambassador, we expect a minimum of four presentations to be done by each Ambassador on an annual basis. Typically, one presentation is generated by Road Scholar and three or more presentations are generated by the Ambassador. Are you able to commit to making four or more presentations per year? If yes, how many? Please list at least four organizations in your community that you plan to reach out to for the purposes of scheduling an Ambassador presentation.   Would you like an experienced Road Scholar Ambassador to contact you to discuss best practices and techniques for securing presentations? Yes No Finally, how did you hear about the Ambassador Program? Website Catalog ENews Letter Friend Other