JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
PULSE Ambassador Signup
Complete this form to apply to be an ambassador for the HAERT Program! Ambassadors will have the job of:
1. Testing out the changes to the HAERT Program
2. Providing input on ways to make the curriculum or UI better
3. Reporting to meetings with the rest of the team at decided times
4. Being positive and enthusiastic about improving the program!
We highly recommend that you apply as it will be a great experience for you!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last name
*
Your answer
Phone
*
Your answer
Email Address
*
Your answer
What high school are you attending?
*
Your answer
What class are you in?
*
Freshman
Sophomore
Junior
Senior
Why are you interested in being an ambassador? (100-250 words)
*
Your answer
Do you have any experience with the HAERT Program (visited our website, completed modules, participated in it at school, etc.)? It is fine if you do not.
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of BSquared Works.
Report Abuse
Forms
