Chancellor's Ambassadors Application Form Breadcrumb Chancellor Leadership Councils and Advisory Board Chancellor's Councils Chancellor's Ambassadors Chancellor's Ambassadors Application Form Section Menu Office of the Chancellor Skip Sidebar Who are the Chancellor's Ambassadors Chancellor's Ambassadors Application Form PERSONAL INFORMATION Name First Last Chattanooga Area Mailing Address Chattanooga Area Mailing Address Street Apt # City State - Select - Alabama Alaska American Samoa Arizona Arkansas Armed Forces (Canada, Europe, Africa, or Middle East) Armed Forces Americas Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming ZIP/Postal Code Phone E-Mail Address Hometown and State Hometown State - Select - Alabama Alaska American Samoa Arizona Arkansas Armed Forces (Canada, Europe, Africa, or Middle East) Armed Forces Americas Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming EDUCATION UTC ID Date of Birth Major Minor Class Standing - Select - Freshman Sophomore Junior Senior Credit Hours Taking Expected Graduation Date Expected Graduation Date: Month Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Expected Graduation Date: Year Year 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041 2042 2043 2044 2045 2046 2047 2048 2049 2050 GPA WORK Do you work during the academic year? Yes No If so, where? How many hours per week do you typically work? SUMMER AVAILABILTY Are you typically available for summer activities? Yes No CAMPUS & COMMUNITY INVOLVEMENT Please include the applicable dates for each item. Please list any campus and community organizations you have been involved in, noting any leadership positions held. Organizations/Positions and Dates Please list any awards/recognitions you have received (examples could include Dean’s List, leadership award, special achievement, etc.). Awards/Recognition Received and Dates Why are you interested in serving as a Chancellor’s Ambassador? What is your favorite way to start a conversation? What is something you’ve done that you’re most proud of? What does it mean to you to be a Moc? On a scale of 1-5 (1 being least comfortable, 5 being most comfortable), please rate your level of comfort with the following: Questions 1 2 3 4 5 Time management 1 2 3 4 5 Meeting new people 1 2 3 4 5 Public speaking 1 2 3 4 5 Conflict management 1 2 3 4 5 Decision making 1 2 3 4 5 Organization 1 2 3 4 5 Leadership 1 2 3 4 5 How did you find out about the Chancellor’s Ambassadors program? Word of mouth Online search Invitation from advisor Other (please specify) Please specify Leave this field blank Tags Office of the Chancellor