Undergraduate Admissions

Student Ambassador Application

Student Information

Name: Banner ID:
Campus/Local Address:
Campus/Local Phone:

Cell Phone:
(including Area Code)

Email Address:

Semester applying for:  

How did you learn about this position?

 

Background Information

Student Status:           Anticipated Graduation Date:
Hometown (including State):
I entered Brockport as a    If transfer, from which college:
Something fun/interesting/unique about you:
Most unique experience at Brockport:
Favorite food at Brockport:
Favorite place to study:
Favorite campus event:
Favorite way to stay active on campus:
Favorite off-campus event/location:
One class every student should take before graduating from Brockport:
Five important things that every freshman should bring to campus:
 

Availability

Please indicate the times below that you are available during the week. You must be available for the entire time frame (or close to the entire time frame).
Monday 10:45 - 11:45 am   Monday 12:45 - 2:15 pm
Tuesday 10:45 - 11:45 am   Tuesday 12:45 - 2:15 pm
Thursday 10:45 - 11:45 am   Thursday 12:45 - 2:15 pm
Friday 10:45 - 11:45 am   Friday 12:45 - 2:15 pm
 

Academic Information

Major(s):     Minor/Certification:

Are you a member of Delta College?   

Are you a member of the Honors Program?

Have you participated in Study Abroad?   

If yes, where?

Honors/Awards/Scholarships Received:
 

Additional Information

Have you ever been documented within the residence halls?

* Being documented does not disqualify an applicant from consideration.

* If you answered yes, please describe the situation, including what actions were taken and how the matter was resolved:

Name of your RD:     Name of your RA:
 
**After you submit this application, you MUST ALSO email a resume OR a PDF version of your myBrockport Co-Curricular Transcript to Jenny Rae Siplo (jrsiplo@brockport.edu). **

   

 

Questions?

Please contact Jenny Rae Siplo by phone at (585) 395-2751 or by e-mail at jrsiplo@brockport.edu.