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.

First

Last

Home Address

Address 2

City/Town

ZIP/Postal Code

Mailing Address

Address 2

City/Town

ZIP/Postal Code

Employer/Organization

What is your profession?

Phone

If you speak, read, and/or write in languages other than English, please list below including your proficiency level:

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:

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 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 actively engage in all Water 101 Academy sessions, 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 and unpaid.
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 affirm that the information provided in this application is complete and accurate. I recognize this is 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