Application for Water 101 Academy / Ambassador Program

First

Last

Address

Address 2

City/Town

ZIP/Postal Code

Employer/Organization

Phone

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 (5 points):

How would the community benefit from your involvement in this program? What would you like to learn and share? (5 points):

If applicable, please describe any relevant community or volunteer experience that would be of benefit to the class (5 points):

Civic Activities: Please list any organizations, associations, or community groups, which you belong to, past or present (5 points):

ACKNOWLEDGEMENT

I understand the participant requirements and would like to apply to the Valley Water Community Water Ambassador Program. I acknowledge that if I am accepted into the program my name, business phone number, email address, employer/school, and job title will be included in the class roster and may be shared with fellow class participants. I authorize the use of any photographic or electronic reproductions of me for any purpose, including, but not limited to educational and other public media, as may be deemed appropriate by Valley Water with no expectation of compensation for the use of this media. By submitting my application I commit to attend all program sessions and attend at least two volunteer or educational opportunities with Valley Water within a year of graduation.

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