El Paso Community College STUDENT AMBASSADOR PROGRAM Application Deadline: August 3, 2015 PERSONAL DATA Name: ______________________________________________ Date: ____________________ Address: ________________________________________________________________________ City: __________________________ State: _____________ Zip Code: ____________________ Home Phone #: __________________________ Cell Phone #: ____________________________ Student ID #: ______________________________ Email Address: ________________________ Are you fluent in a language other than English? _______________________________________ Academic Information Please check the degree(s) that you are pursuing at EPCC and list your major:  AA  AS AAS Major: ____________________________________________________________ Are you a:  New Student  Returning Student  Part time  Full Time Student ID#: _____________________________ Overall G.P.A.: ______ How many credit hours have you completed at EPCC? ______ Name and location of High School: ________________________________________________________ Have you attended any other colleges?  Yes  No if yes, where? ____________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ List other financial assistance that you receive (this includes scholarships, financial aid, or other sources) Source of assistance ____________________________________________________________________ Source of assistance ____________________________________________________________________ Rev 06/04/15 Why would you like to be a Student Ambassador? _____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________ Please grade yourself in the following areas. Use the following scale: O=Outstanding E=Excellent G=Good _____ Attitude _____ Organizational Skills _____ Public Speaking _____ Self‐Motivation _____ Interpersonal Communication _____ Team Oriented _____ Time Management _____ Computer Skills A=Average F=Fair _____ Leadership _____ Cultural Awareness or Cultural Competency List extracurricular activities/organizations you have been involved in at EPCC? _____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________ EMPLOYMENT INFORMATION  Not Employed  Part‐Time  Full – Time Employer Name: _____________________________________________________ Hours per Week: __________________________Position: ___________________ Do you have dependable transportation? ______________Can you travel? ______ Will you be employed elsewhere during the academic year?  Yes  No If yes, what hours do you work? _____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________ Rev 06/04/15 Please list your available times to work/volunteer for Fall 2015 Mondays: __________________________________________________________________ Tuesdays: __________________________________________________________________ Wednesdays: __________________________________________________________________ Thursdays: __________________________________________________________________ Fridays: __________________________________________________________________ Saturdays: ________________________________________________________________________ Please list any campus or community services and/or volunteer work you are or have been involved with? Example: clubs, organizations, community service, etc. Please list the most recent items first. Organization/Activity Position/Duties Dates Contact Person/Phone STATEMENT OF COMMITMENT: I have reviewed the Student Ambassador Application and agree to support the guidelines of this program. I am aware that if selected, I will be required to take the Spring Leadership EPCC course, attend the Fall Leadership Conference and maintain a 2.5 GPA in my academic level classes. By signing below, I certify that the above information is current and true as of the date indicated below. Signature: ______________________________________ Date: ________________________ CONSENT FOR VERIFICATION OF STUDENT RECORDS: I grant permission to an authorized representative of El Paso Community College to verify my student records for purposes of this application. Signature: ______________________________________ Date: _______________________ Submit application and current college or high school transcript to:
Director of Student Leadership & Campus Life
Valle Verde Campus, Building C Room 107
Rev 06/04/15 APPLICATION CHECKLIST: Please ensure that you have submitted all of the following materials:  Completed Application 



Provide two (2) Letters of Recommendation – Using two (2) different sources, for example: Former Employer(s), Former Professor(s)/Teacher(s), Club advisor etc. not family members or significant others. Letters MUST be in a signed and sealed envelope. Current college or high school transcripts Interviews Scheduled Date: August 10‐11, 2015 I will attend Ambassador Training: August 20‐21, 2015 from 9:00 – 3:00 Return completed application to: Arvis C. Jones Director, Student Leadership & Campus Life Valle Verde Campus, C107 915.831.2712 Rev 06/04/15