Thank you for your interest in being a PrEP Aware Week 2024 Ambassador!

We are looking for 8 individuals to serve as ambassadors for New York State's PrEP Aware Week in October 2024 who are representative of the diverse group of individuals using and advocating for PrEP for HIV prevention. We invite you to submit the form below to help us get to know you!

Please note that submitting an application does not guarantee selection to be an ambassador.

For questions or assistance filling out the application, please contact Sonya Khan at skhan@impactmarketing.com.

Please submit your application no later than April 30, 2024. Applicants will be notified of selection the first week of May.

Thank you!

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* 1. What is your email address?

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* 2. What is your name?

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* 3. What is your date of birth?

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* 4. What is your phone number?

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* 5. What is your gender?

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* 6. What are your pronouns?

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* 7. What race or ethnicity best describes you?

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* 8. Do you identify with any of the following groups?

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* 9. What languages are you comfortable communicating in for a recorded video?

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