Student Ambassador Application

Student Ambassador Application GENERAL INFORMATION: Name: Address: City: State: Zip Code: County: JCC Student ID Number: Telephone Number: Cell Phone Number: Email Address: EDUCATIONAL INFORMATION: High School Name: City: State: Zip Code: Cumulative GPA in High School: Please complete below information if currently enrolled at JCC or another college: College Name: City: State: Zip Code: Cumulative GPA at JCC or other college: Program of Study: Cumulative Credit Hours (Johnston Community College students only): Anticipated Graduation or Transfer Date: Updated - January 12, 2017

ANSWER EACH OF THE FOLLOWING QUESTIONS ON SEPARATE SHEETS OF PAPER. EACH RESPONSE SHOULD BE NO MORE THAN 500 WORDS. PLEASE INCLUDE YOUR FULL NAME ON THE TOP RIGHT CORNER OF EACH ESSAY. 1. Biography about yourself. 2. List ALL special awards, community service, talents, hobbies and interests. 3. Why did you decide on your program of study? 4. What are your plans after graduation? 5. Why would you be an effective Ambassador? 6. What one thing would you like the Ambassador Advisor to know about you? or If you are a current Ambassador, why are you seeking to reapply to the program? Please provide two letters of reference to accompany your application. Each letter must be mailed directly to Tiffany Trujillo from the reference. (One professional and one personal reference) Applicant s Signature Date COMPLETED APPLICATION, SIGNED CONTRACT, ESSAY QUESTIONS, AND REFERENCES MUST BE SUBMITTED TO TIFFANY TRUJILLO IN THE FOUNDATION OFFICE AT JOHNSTON COMMUNITY COLLEGE BY FRIDAY, MARCH 31, 2017. MAIL TO: TIFFANY TRUJILLO AMBASSADOR ADVISOR JCC FOUNDATION OFFICE P.O. BOX 2350 245 COLLEGE RD. SMITHFIELD, NC 27577 LATE OR INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED. Updated - January 12, 2017

Student Ambassador Contract If selected, I agree to meet the following expectations during my year as an Ambassador: 1. Participate in required functions and complete one service hour per week in Student Services or Foundation offices (approximately 120 hours a semester) 2. Attend all requested events and activities* 3. Attend scheduled monthly meetings 4. Attend recruiting events and conduct tours of the campus 5. Participate in the Ambassador retreat and orientation training sessions 6. Forfeiture of any other JCC Foundation scholarship awarded through johnstoncc.academicworks.com 7. If I withdraw from or am terminated from student ambassador duties prior to fulfilling my year-long commitment, I may be required to repay my scholarship to JCC. *Events and activities may occur at or with religious organizations and fall on weekends. Please do not apply for this scholarship if you will be unable to fully participate in all functions. If selected to represent Johnston Community College as a Student Ambassador, I will receive: 1. Full tuition, activity and technology fees for one year FOR FALL AND SPRING SEMESTERS ONLY (in-state tuition rate) 2. Personal and professional development 3. Clothing and name tag 4. Opportunities to meet community and state leaders and become acquainted with trustees, foundation board, faculty, and staff 5. Membership of a small, exceptional group of students committed to the success of JCC and its students I understand that I will be excluded from further participation in the Ambassador Program if any of the following conditions occur: 1. Seek nominations for/or become a SGA officer 2. Become enrolled for less than 12 semester hours with exception of the summer semester 3. Loss of good standing within the College or community 4. Cumulative grade point average drops below a 3.0 5. Failure to fulfill the standards of the program (including class and meeting attendance, behavioral expectations, leadership class completion, minimum weekly service hours and other mandatory functions) Page 1 of 2

NOTE: Termination or withdrawal from the Ambassador program requires the return of all items provided by Johnston Community College, and you may be required to repay the ambassador scholarship to JCC. Failure to return Ambassador materials will result in a hold placed on all grades released and future transcript requests. In addition, by accepting this scholarship, the student agrees to forfeit any other JCC Foundation scholarship awarded through johnstoncc.academicworks.com. (Outside or third party scholarships may be retained.) I,, have read the above and agree to fulfill these requirements if selected. Date: Page 2 of 2

Student Ambassador Reference Form (this form is supplemental to the reference letter) Name of Applicant: Your Name: Relation to Applicant: Phone # This form is supplemental to the reference letter. You may fill out this form for the student who has asked you to be a reference and enclose it with your letter in sealed envelope. Please return letter of recommendation and this form to: Tiffany Trujillo, Advisor to Ambassadors JCC Foundation PO Box 2350 245 College Road Smithfield, NC 27577 Please circle the number which best describes this student on each of the following characteristics: Excellent Good Average Poor N/A ACADEMIC PERFORMANCE 1 2 3 4 5 LEADERSHIP 1 2 3 4 5 ATTENDANCE 1 2 3 4 5 RESPONSIBILITY 1 2 3 4 5 RESPECT SHOWN FOR OTHERS 1 2 3 4 5 PUNCTUALITY 1 2 3 4 5 WILLINGNESS TO TRY SOMETHING NEW 1 2 3 4 5 OVERALL ATTITUDE 1 2 3 4 5

Are there other factors that you feel might assist in determining whether this student should be selected as a member of the 2016-2017 Johnston Community College Student Ambassador Program? Signature: Date:

Student Ambassador Reference Form (this form is supplemental to the reference letter) Name of Applicant: Your Name: Relation to Applicant: Phone # This form is supplemental to the reference letter. You may fill out this form for the student who has asked you to be a reference and enclose it with your letter in sealed envelope. Please return letter of recommendation and this form to: Tiffany Trujillo, Advisor to Ambassadors JCC Foundation PO Box 2350 245 College Road Smithfield, NC 27577 Please circle the number which best describes this student on each of the following characteristics: Excellent Good Average Poor N/A ACADEMIC PERFORMANCE 1 2 3 4 5 LEADERSHIP 1 2 3 4 5 ATTENDANCE 1 2 3 4 5 RESPONSIBILITY 1 2 3 4 5 RESPECT SHOWN FOR OTHERS 1 2 3 4 5 PUNCTUALITY 1 2 3 4 5 WILLINGNESS TO TRY SOMETHING NEW 1 2 3 4 5 OVERALL ATTITUDE 1 2 3 4 5

Are there other factors that you feel might assist in determining whether this student should be selected as a member of the 2016-2017 Johnston Community College Student Ambassador Program? Signature: Date: