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Application for Water 101 Academy / Ambassador Program

Name
Home Address
Mailing Address
What language(s), other than English, do you
Are you available to attend ALL of the sessions when scheduled? (NO response may disqualify candidate)
How did you hear about the Water 101 Academy/Ambassador Program?
Were you referred by a past Water Academy participant or Valley Water Board Director? If so, please state who:
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)
Given the choice, what is your preferred Water 101 Academy participation mode?
in person with the ability to attend remotely if I can’t make it in person.
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.

 
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