AYA Health Youth Ambassador Application

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Email *

Student First Name *

Student Last Name *

Guardian First Name *

Guardian Last Name *

Guardian Email Address *

What country do you live in? *

What city do you live in? *

What grade are you in school? (Please write in international equivalent) *

Grade 9

Grade 10

Grade 11

Grade 12

1st year in college

Other:

What is the name of the school you attend? *

Have you previously been an ambassador? *

Yes, I have been an ambassador for other programs or organizations.

No, I have not been an ambassador before.

If you have a LinkedIn, please provide the link here. *

We want to have this information so we can connect once you become an ambassador! Please include this even if you feel that your LinkedIn is not "up to par". We will not be evaluating your LinkedIn as part of the application.

If you have an Instagram, please provide your Instagram handle or a link to your profile here. *

If you'd like, please follow @ayausc. We will be posting upcoming events, AYA spotlight, featured healthcare professional and more on Instagram! If you don't have an account, you can leave this blank.

Are you part of any extra-curricular activities? *

Computer Science (e.g., Robotics Team, CS Club, AI Club.)

Health & Science related (e.g., Science Club, Health Club)

Student government (e.g., President, Student Council)

Business/Finance (e.g., Finance Club)

Games/hobby (e.g., Chess Club)

Art, Music, Theater (e.g., Art club)

Communication (e.g., Journalism, Speech Club, Debate Team)

Volunteering (e.g STEM outreach)

Other:

Required

List the clubs/teams you are in and describe briefly with 1 sentence. Separate with semicolon (;) *

Example: Beckman High School Computer Science Club, Computer Science, "1 sentence description"; STEM Outreach Club, Volunteering, "1 sentence description"

In the Ambassador program, I am especially interested in: *

Gaining healthcare knowledge and skills, by attending sessions with healthcare professionals

Collaboration and Project Creation, by connecting with exceptional high school students from around the world on building projects, attending competitions, etc.

Leadership, by organizing an AYA Health Club at my High School.

Technical Writing and Research, by writing blog posts about AYA@USC.

Content Creation, by creating and sharing social media content (TikTok, Instagram) about AYA@USC

Event Planning and Coordination, by organizing an event in my city or school.

Other:

Required

What do you hope to get out of the AYA Health Youth Ambassador program? (50-100 words) *

I have previous experience in: *

Researching and writing blog posts, articles, and essays.

Photo and video content creation (Youtube, Tiktok, etc.)

Organizing live in-person or online events.

Club leadership.

Writing for the school newsletter

Other:

Required

Please describe your experiences here briefly. *

Please write N/A if not applicable.

Do you know of any upcoming health fair in your area? Write the names and dates if so! *

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