Plymouth Independent Ambassador Registration

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At the Plymouth Independent, our ambassadors will be at the heart and soul of our mission—a collective force that brings our vision to life. We are immensely grateful for your dedication and the invaluable contribution you will make to our organization.

To ensure that we fully understand your unique perspectives, passions, and aspirations, we kindly request a few moments of your time to complete a brief survey. This survey will help us get to know you on a deeper level, enabling us to provide tailored support and resources that align with your interests and objectives.

Your responses will allow us to curate content, training, and opportunities that align with your unique talents and aspirations.

Thank you, once again, for your dedication and support!

Please note: This ambassador survey will solely be utilized for internal purposes, helping us to gain a clearer understanding of our ambassador group's composition and better tailor our initiatives to the diverse needs and strengths within our team.

Required Questions

First Name *

Last Name *

Email Address *

Phone Number *

Mailing Address *

What village center(s) do you identify with? *

What age range are you in? *

Under 25 years

25-44 years

45-64 years

65+ years

Do you have any social media accounts where you would be open to occasionally sharing posts from the Plymouth Independent? *

Yes

Optional Questions

Which categories describe you? (select all that apply)

Native American or Alaska Native

Black or African American

East Asian - Chinese, Korean or Japanese

Hispanic, Latino or Spanish origin

Middle Eastern or Northern African

Native Hawaiian or Other Pacific Islander

South Asian - Indian or Pakistani

South East Asian - Cambodian, Thai, Vietnamese, Filipino, or Hmong

White

Prefer not to answer

Not listed here (optional to specify under 'other')

Other:

Which of the following best describes you (select one)

Female

Male

Prefer not to answer

I prefer to self-identify (optional to specify below)

Clear selection

I self identify as:

What is your current marital status?

Single

Married

Living with partner/significant other

Separated or divorced

Widowed

Prefer not to answer

Clear selection

Are there any children 17 years of age or younger living in your household? (select all that apply)

No kids living in my household

0-1 years old

2-3 years old

4-8 years old

9-12 years old

13-17 years old

Prefer not to answer

What is the highest level of education you have completed?

High school diploma or equivalent

Some college, no degree

Technical, vocational or associate’s degree

Bachelor’s degree (BA, AB, BS, etc.)

Graduate school or professional degree (MBA, MD, JD, MS, PhD, etc.)

Prefer not to answer

Clear selection

Current Employment Status

Working full-time

Working part-time

Studying/in school

Not working/homemaker

Unemployed

Retired

Military

Prefer not to answer

Clear selection

If you are currently employed, who is your current employer and what is your role?

What other professional experience do you have?

Are you a member of any professional groups or networking organizations?

Are you a member of any clubs, religious organizations, or volunteer groups?

What kinds of recreational activities do you enjoy?

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