Please complete the application to determine if you are a candidate for the Ambassador Program.

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* 1. Full Name:

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* 2. Firm Name:

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* 3. You would be assigned to and connected with such a member (the Mentee) for a period of up to six months. Are you able and willing to be available to the mentee(s) via phone and email--responding promptly? 

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* 4. The purpose of the Ambassador Program is to help members who are struggling with their membership. As a potential Ambassador, would you be willing to share how ElderCounsel resources helped you build your practice and gain confidence with a member who is struggling in some way?

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* 5. What year did you join ElderCounsel?

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* 6. Which of the following words would you best describe yourself?

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* 7. What areas of practice do you focus on most?

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* 8. How often do you or your staff utilize ElderDocx?

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* 9. How would you rate the quality of ElderDocx on a scale of 1-5, 5 being the best on the market?

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* 10. How would you rate the quality of the ElderDocx tutorials on a scale of 1-5, 5 being a strong training solution to learn how to draft in ElderDocx?

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* 11. What resources do you or your staff utilize most often (select all that apply)?

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* 12. How would you rate the quality and value of ElderCounsel education on a scale of 1-5, 5 being the best education available to elder law attorneys?

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* 13. How often do you, or a member of your firm, use the ElderCounselor newsletter content that is available every other month?

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* 14. How often do you, or a member of your firm, post to the listserv or online discussion forum?

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* 15. How often do you, or a member of your firm, access the store to make purchases?

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* 16. How often do you, or a member of your firm, speak with your Membership Representative?

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* 17. Are you a member of our Practice Enhancement Program (PEP)?

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* 18. If yes, what PEP benefits do you or your staff utilize most?

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* 19. Are you willing to share state-specific checklists and forms pertaining to Medicaid, VA and Special Needs application processes or other documents that you have created/have available to aid other members of ElderCounsel?

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* 20. Do you have experience delivering presentations to other professionals?

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* 21. Are you interested in speaking on state-specific topics and strategies?

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* 22. What marketing strategies do you, or another member of your firm, utilize in your practice?

Thank you for your interest in ElderCounsel's Ambassador Program. Your application will be reviewed and someone will be in touch with you within the next few business days to discuss next steps.

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