Civic Ambassador Application Question Title * 1. Name Question Title * 2. Email Question Title * 3. Affiliated Organization Question Title * 4. City/Town of Residence Question Title * 5. Gender Identity Male (Cis) Female (Cis) Not listed (please specify) Question Title * 6. Race Ethnicity Question Title * 7. Age Range Under 18 18-24 25-34 35-44 45-54 55-64 65+ Question Title * 8. Tell us about your current civic engagement experience Question Title * 9. What is a major effort you plan to undertake as a Civic Ambassador Question Title * 10. PLEASE CHECK THE BOX IF YOU AGREE: I understand that the Civic Ambassadors Program is a non-partisan program and affirm that I will not attribute any partisan or political party campaign or related work that I may do as an individual as being part of my Civic Ambassador role. As a Civic Ambassador I will endeavor to work with others for the betterment of my community without regard for their political orientation, affiliation, or beliefs. By checking the box and typing my name below, I am electronically signing my application. I agree Please write your name and date (mm/dd/yy) Question Title * 11. Additional Questions or Comments Done