Institutional Ambassador Application

First Name *

Last Name *

Email *

Name of institution/agency where you are currently employed. *

Have you attended OKWHE events in the past? *

Yes

List previous OKWHE events you have attended or at which you were a presenter.

Why do you want to be an Institutional Ambassador? *

Name of Dean/Chair/Supervisor *

Address for Dean/Chair/Supervisor *

Email address for Dean/Chair/Supervisor *

Name of Institution's President. *

Email address for President. *

I understand that as an Institutional Ambassador (IA) my role is to: 1. Attend two IA meetings per year. One IA meeting must be attended in person. 2. Hold at least one OKWHE event on my campus or in my region per year. 3. Submit an event report to the IA Chair. *

Yes

Upload a letter of support from your immediate supervisor (i.e. dean/chair/department head) *