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Application for Water 101 Academy / Ambassador Program
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Application for Water 101 Academy / Ambassador Program
NOTE: Please ensure all answers are complete and thorough. Valley Water Board of Directors will be reviewing applications for final selection.
Name
First
Last
Home Address
Home Address
Address 2
City/Town
ZIP/Postal Code
Mailing Address
Mailing Address
Address 2
City/Town
ZIP/Postal Code
Employer/Organization
What is your profession?
Email
Phone
What language(s), other than English, do you
Speak
Read
Write
Name of language:
Enter other…
Are you available to attend ALL of the sessions when scheduled? (NO response may disqualify candidate)
Yes
No (please explain)
How did you hear about the Water 101 Academy/Ambassador Program?
District website
District newsletter
NextDoor post
Other (please explain)
Were you referred by a past Water Academy participant or Valley Water Board Director? If so, please state who:
No
Yes, name of person:
Please describe your interest and explain why you would be a good candidate to consider for the academy/ambassador program. How might your community benefit from your involvement?
What type of Valley Water work are you most interested in learning about or contributing to?
Please indicate if you are currently or have been in the past, a member/officer/ participants/staff of any of the following types of organizations. (Check all that apply)
Neighborhood association
Church group/faith-based organization
Professional organizations
Community groups
Civic organizations
Non-profit: Social Services
Non-profit: Environmental
Non-profit: Education & Advocacy
Societies & clubs
Other…
Enter other…
Please list below the organizations you are currently still involved with or connected to.
Given the choice, what is your preferred Water 101 Academy participation mode?
I’d prefer to attend in person
I’d prefer to attend virtually
I don’t have a preference
I’d prefer a hybrid option
in person with the ability to attend remotely if I can’t make it in person.
ACKNOWLEDGEMENT
I am hereby applying for admission to the Water 101 Academy with the goal of becoming a Water Ambassador for Valley Water.
If accepted I understand that:
I must be able to participate in all Water 101 Academy session, to the best of my ability
It is my responsibility to notify Valley Water staff of any changes to my ability to continue participating
If selected to participate and I am unable to meet my commitment, my space in the Academy may be forfeited
Participation in the Water 101 Academy is completely voluntary
Successful completion of the Water 101 Academy is required for me to be inducted as a Water Ambassador
I acknowledge that if I am accepted into the program, my name, phone number, email address, occupation, employer/organization and/or affiliations will be included in the class roster and may be shared with fellow class participants.
I hereby grant full permission to Valley Water, its directors, officers, employees, and agents to capture and use photographs, videotape, motion pictures, recordings and any other media records of me for any purpose whatsoever, that such material remain the sole property of Valley Water and that I shall receive no compensation for the use of this media.
I commit to attending all program sessions and participate/support at least two initiatives, volunteer/educational opportunities, or other Valley Water calls to action within a year of graduation.
I affirm that the information provided in this application is complete and accurate. I recognize this in only an application and in no way guarantees admission into the Water 101 Academy.
By signing and submitting this application
, I commit to fulfilling the participation and water ambassador expectations to the best of my ability and to notify Valley Water staff at
[email protected]
should I have any questions or my availability change.
SIGNATURE (use mouse or finger to sign)
Sign above