1. PERSONAL INFORMATION

Name of Applicant:	Mr. Ms. Mrs.
Current Mailing Address:
Email Address:
Phone Number:
Date of Birth:
Current GPA (H.S. or College):

2. ACTIVITIES AND ACHIEVEMENTS

List accomplishments, positions of leadership, membership in organizations, honors, awards, part-time jobs, community service, etc.

High School

College

Community

Other

3. SPECIAL TALENTS OR ABILITIES

List any special talents, abilities, or general interests. (Example musical or dramatic talents, writing or speaking abilities, athletic ability, etc.)

4. STATEMENT OF EDUCATIONAL PLANS, CAREER OBJECTIVES, AND PERSONAL GOALS

In the space provided, write a concise narrative statement in your words expressing your educational plans, career objectives, and personal goals.

5. AMBASSADOR PROGRAM IMPACT

I plan to attend Lone Star College-Kingood through the	Fall Spring Summer	semester of
Write a 250-word essay exlaining why you might like to be part of this program. What do you think you can contribute to the ambassador program and its mission of student recruitment and retention? Send essay to Richard.Walsh@lonestar.edu.

6. HOW DID YOU HEAR ABOUT THE AMBASSADOR PROGRAM?



7. REFERENCE AND SUPPORTING INFORMATION

List the names and addresses of 2 references (high school counselor, employer, character reference, activity sponsor, ec) that you have requested to send a confidential evaluation to support your application. It is your responsibility to have a confidential evaluation sent to Richard.Walsh@lonestar.edu or delivered to the office designated below.

8. BACKGROUND CHECK

As part of the application process, you must be willing to submit to a background check. At the time of your interview, you will be requested to complete an Authorization to Release Information form. Once you are selected to serve as an Ambassador, the Authorization to Release Information will be processed.

Yes, I will agree to a background check     No, I will not agree to a background check

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Office:

Rick Walsh, M.Ed. Orientation Coordinator Lone Star College-Kingwood 20000 Kingwood Drive Kingwood, TX 77339 Richard.Walsh@lonestar.edu

Lone Star College-Kingwood is committed to the principle of equal opportunity in education and employment. The college does not discriminate against individuals on the basis of race, color, sex, religion, disability, age, veteran, nationality, or ethnicity in the administration of its educational policies, admission policies, employment policies, scholarship and loan programs, and other college administered programs and activities.