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SafeTeens Online Ambassador Application Form

Ambassador

Thank you for your interest in the SafeTeens Online. We are excited that you are considering joining us in our goal in raising awareness on online safety and security among teenagers. Our mission is to educate young adults by creating awareness among themselves and in the community by their peers about Internet safety and providing tools and knowledge to enable to do more online safely and securely. If you have any questions please e-mail to admin@safeteensonline.org
1.Name(Required.)
2.Gender
3.Grade
4.Address
5.E-mail
6.School
7.Why do you want to be Chapter leader for SafeTeens Online?* (50 words or less)
8.Are you willing to conduct online awareness activities at your school (start a club/write in a newspaper/ peer education) to support the mission of SafeTeensOnline
9.How many hours per month are you willing to dedicate to SafeTeensOnline activities? (Meetings/video recordings/blogs etc.)

10.If you are under 18 years of age, do you have permission of your parent/guardian to put your profile/story/blog on the website (https://www.safeteensonline.org)?

11.If you are under 18 years of age, do you have permission of your parent/guardian to include your photo/video/profile online in relation to your activity (safeteensonline YouTube channel/ share on safeteensonline twitter / include that on website etc.)?

12.Please type your name and parent/guardian name in the following box to grant permission to all of the above. By submitting this application, I affirm that the facts set forth in it are true and complete.