Ambassador Application

Ambassador Program

Application & Selection Process

Thank you for your interest in becoming a peer mentor Ambassador. In order to be qualified to be a Triumph Ambassador you must fulfill the following requirements.

1. Must live in Southern California
2. Must be at least 2 years post injury
3. Must have successfully adapted to life with spinal cord injury/disorder and be reintegrated back into the community
4. Must be an active participant in Triumph support groups (have attended a minimum of 5 meetings)

There is a multi-step selection process:

Step 1: Complete Application
Step 2: Reference Check
Step 3: Two-Part Interview Process
Step 4: Training and Certification

*The selection process takes place on a quarterly basis, and applicants will be selected based off areas of need for Triumph's programs

Application

First Name*

Last Name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Email*

Date of birth*

Month

Day

Year

Gender*

Veteran*

Race / Ethnicity*

Do you speak a second language?*

If yes, which language?

Disability Type*

Injury Level / Description*

Date of Injury/Diagnosis*

Month

Day

Year

Cause of Injury*

Where did you attend Rehab?*

If Rehab not listed above: Where?*

What Triumph support groups have you attended?*

If Support Group not listed above: Where?*

What areas are you willing to serve? (Check all the apply)*

Tell us about yourself*

Why are you interested in being an Ambassador?*

What aspects of being a peer mentor relate specifically to your talents or interests?*

Share some of your successes since the onset of your SCI/D*

How would you rate your mental health?*

Poor

Moderate

Good

Excellent

Do you currently attend a Triumph SCI support group?*

If yes, which one?*

If Support Group not listed above: Where?*

Did you have a peer mentor?*

If yes, discuss the most rewarding and challenging aspect of your peer mentor experience?*

If no, discuss what you wish someone could have shared with you to help improve your experience and recovery.*

How did you learn about Triumph?*

Upload a current full body picture of yourself*

Max. file size: 64 MB.

Triumph Affiliate Reference*

First Last

Email*

Triumph Affiliate Reference Email

Phone*

Triumph Affiliate Reference Phone

Relationship to Triumph Affiliate Reference*

Family, Friend, or Colleague Reference*

First Last

Email*

Family, Friend, or Colleague Reference

Phone*

Family, Friend, or Colleague Reference

Relationship to Family, Friend, or Colleague Reference*

Upload a letter of recommendation*

Max. file size: 64 MB.

Hidden

Hidden: Form Date

Hidden

Hidden: 01. Has a Disability?*

Hidden

Hidden: 07. Life Cycle - Ambassador Application Date

Hidden

Hidden: 06. Life Cycle - Applied to become Ambassador?*