Ambassador Application

Ambassador Program

Application & Selection Process

Thank you for your interest in becoming a peer mentor Ambassador. 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.

*Applicants to become Ambassadors must have Spinal Cord Injury/Disorder for a minimum of two years, are active members our SCI support groups for at least six months, and have successfully reintegrated back into the community.

Application

First Name*

Last Name*

Address*

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

Phone*

Email*

Date of birth*

YYYY

Gender*

Veteran*

Race / Ethnicity*

Disability Type*

Injury Level / Description*

Date of Injury/Diagnosis*

YYYY

Cause of Injury*

Where did you attend Rehab?*

If Rehab not listed above: Where?

What areas are you willing to serve? (only check where you are able to visit regularly)*

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 have reliable transportation?*

Do you currently attend a Triumph SCI support group?*

If yes, which one?*

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: 1 GB.

Upload a letter of recommendation

Max. file size: 1 GB.

Please provide a letter of recommendation from one of the following: a personal friend/caregiver, a leader of a support group you attend, or a therapist/trainer.

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Hidden: Form Date

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Hidden: 01. Has a Disability?*