Worcester State University

Application for Returning Presidential Ambassador

If you are applying and are currently an Ambassador please fill out this form.

First
 

Middle

 
Last


Home Address


Dorm & Mailbox # (If you live on campus)  


Student ID Number


Cell Phone
 

Email 


Housing Status

Major Biology Biotechnology Business Administration Chemistry Communications Communication Sciences & Disorders Community Health Computer Science Criminal Justice Early Childhood Education Economics Elementary Education English Geography Health Education History Mathematics Natural Science Nursing Occupational Studies Psychology Sociology Spanish Urban Studies Visual & Performing Arts Undeclared

Minor Art Bioinformatics Business Administration Chemistry Communications Communication Sciences & Disorders Computer Science Economics English French Geography Gerontology Global Studies Health Education Health Fitness History Information Technology Intergenerational Studies & Community Service Mathematics Middle East Studies Middle School Education Music Natural Science Nuclear Medicine Technology Philosophy Philosophy & Law Physics Political Science Psychology Secondary Education Sociology Spanish Sport Coaching Theatre Urban Studies Web Development Women's Studies

Anticipated Graduation Year


Cumulative GPA
 

Are you currently employed on campus?

Hours per week?


Please list below your on campus employment information

Campus Office


Supervisor


Work Schedule


Please list any off campus employment

Employer


Supervisor


Work Schedule


Please list any other campus activities/clubs/sports you are involved in.

 
Why do you want to return to be a PSA? What does it mean to you to be a returning PSA? How is that different from being a new PSA?


What Leadership skills, or personal characteristics would you like to strengthen as a returning PSA?
 

What you would you tell a new PSA about what it means to be a PSA?


What topics would you like to see in training this year?
 


Please provide the name of two faculty or staff members you would like to use as a reference, they should each submit a letter of recommendation.
 
Reference 1

Name


Department


Email


Phone


Reference 2

Name


Department

 
Email


Phone


Ambassador Questions may be submitted to:

• studentambassadors@worcester.edu
• Or by calling 508-929-8020

Attention, you must available to attend all regularly scheduled bi-weekly meetings during the academic year.

I have read the above requirements. I also give permission for you to verify my GPA with the Registrar’s office, Judicial Records, and to request a CORI check. I hereby authorize said institutions to release these forms.

Student Name


Student ID #


Student Signature


Date
 [None]