Safe Sports Student Ambassador Program

Student Application

Please fill out the all of the following information including your name and address (even if you are already a student ambassador). The application deadline is September 30th. Thank you!

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* 1. Name and Contact Information

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 2. Name of School

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* 3. Current Grade

9th (Freshman)

10th (Sophomore)

11th (Junior)

12th (Senior)

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* 4. Were you a Student Ambassador at the Spring Social in March 2019

Yes

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* 5. Emergency Contact Information

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 6. Emergency Contact Relationship to Applicant

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* 7. Are you currently playing a sport?

Yes

Not fall season, but will play in the winter or spring

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* 8. Do you know a Safe Sports Network Athletic Trainer? If yes, who?

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* 9. Why are you interested in becoming a Safe Sports Ambassador?

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* 10. What qualities do you have that would make you a good Student Ambassador?

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* 11. How did you learn about the Safe Sports Student Ambassador Program?

Through my school's athletic trainer or coach

Through my parent

Other (please specify)