2022-23 First2 Ambassador Request Form

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Welcome teachers and administrators Please use this form to request an undergraduate student to visit your classrooms to chat with students about succeeding in college as a STEM major. Once you have submitted the information, we will e-mail you and begin connecting you with an ambassador that can facilitate your request. Thank you!

Email *

Your Name
*

School or organization name
*

Your email address
*

Phone number where we can contact you
*

Alternative phone number
*

Days and times when we can contact you (For example your planning period)
*

School or Organization Address
(What is the location where an Ambassador will visit?)
*

How many rotations of Ambassador presentations are desired? (expect each chat to take 1/2 hour to 45 minutes- A maximum of 4 rotations on one day please!)
*

Grade level(s) to be visited
*

Estimate how many students total would an Ambassador see in a visit? (An exact number isn't needed)

Preferred Dates(s) and Times. We will do our best to accommodate your requested date, but please recognize that our Ambassadors are busy college students and some flexibility is necessary. *

Are you interested in a virtual visit?

Yes

Maybe

Clear selection

Please give us an idea of the supplies you have. Check all that apply.

projector, screen or blank wall and dark room

computer with internet access or flashdrive plug in

microphone (needed for large groups)

Zoom or Teams capability

If a specific student has already contacted you to come visit your classes, enter their name here:

Anything else you would like to add?

Submit

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