Ambassador Program Please fill out the form below. Questions? Reach out to info@epilepsywisconsin.org Name * First Name Last Name Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Are you Seizure First Aid Certified through the Epilepsy Foundation? * Yes No What is your connection to epilepsy? * Are you able to drive? * This in not a requirement, but there are opportunities to travel throughout the year. Yes No Do you use any form of social media? * This is not a requirement, but may be useful in certain areas. Yes No Have you attended any Epilepsy Foundation events in the past? * If yes, please list. Have you volunteered for the Epilepsy Foundation in the past? (Yes/No) * * If yes, please list. Do you have any other volunteer experience? (Yes/No) * If yes, please explain. Are you an ambassador for any other organizations? (Yes/No) * If yes, please list. How did you hear about this opportunity? * What interests you most about this program? * What interests you most about this program? * Why do you want to be an Ambassador for the Epilepsy Foundation of Wisconsin? * Are you currently employed or in school? (Yes/No) * Please tell us where. What are some things you are passionate about? * What are some things you are passionate about? * Thank you! You will hear from us soon!
