Student Wellbeing Ambassador Interest Form

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Are you interested in learning more about the Wellbeing Ambassador (WA) program? Please fill out this short interest form with your contact information. Someone from the Office of Student Wellbeing (OSW) will reach out to you.

There is no commitment to joining the program by filling out this form, and this form does not constitute a formal application to the WA program. You will be contacted with an opportunity to apply to the program if you are interested in submitting an official application.

If you have any questions or concerns in the meantime, please do not hesitate to reach out to Grace Conte-Bennett, Assistant Director of the Office of Student Wellbeing at gracecb@mit.edu.

(Marketing poster is included below)

Your First & Last Name: *

If you have a preferred name, please list it below (optional):

Pronouns (optional):

Are you a student?

Undergraduate Student

Graduate Student

Other:

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Your MIT Email Address: *

If you do not have an MIT email address, please share an alternative email address:

Why are you interested in the WA program?

I am a student interested in applying to the program.

I am a student who wants to learn more about the WA program before I decide to apply.

I am not a student at MIT, but I want to learn more about the WA program.

I am a student who wants to learn more, but cannot attend the Info Session .

Other:

Please share any questions that you would like answered about the WA program:

Any additional details that you feel would be helpful for us to know:

By submitting this form, you are granting your permission to be contacted about the WA program.

WA Interest Marketing Poster:

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