Student Ambassador Nomination

This form must be received by Lisa Manuell (BD) no later than Tuesday, February 1. Late and/or incomplete nominations will not be accepted under any circumstances. (Tight deadlines under the direction of the state office)

Student's Name*
Student's ID#*
Campus Affiliation*
Address*
Street Address City State ZIP Code
Phone*
Email*
Student's Area of Study*
Current Semester*
Student's Anticipated Graduation Date*
Eligibility
Has the student been accepted and enrolled in a technical diploma or Associate degree program?*
Has the student completed at least one semester of study?*
Will this student be enrolled at Moraine park throughout, and have the ability and willingness to serve as Moraine Park’s District Student Ambassador for the entirety of the 2022-23 academic year as well as attend the Statewide Ambassador Event on Thursday, April 21 and Friday, April 22, 2022 in Wisconsin Dells? (Attend one-on-one session with Dan Arneson for recognition video capture.)*
Qualifications
Using Moraine Park’s Career and Life Skills, please outline the reasons you feel this student would be a good Ambassador for the Moraine Park Technical College District.*
Nominator Verification
I hereby submit the above named student to represent the district of Moraine Park Technical College as a candidate for the Wisconsin Technical College System State Ambassador program.*
Nominator Name*
Relationship to Student*
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Student Ambassador Nomination

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