Ambassador Recruitment Form

Potential Student Information: * Required

First Name:*

Last Name:*

Home Number:

Cell Number:* (999) 999-9999

Email:*

Mailing Address:*

Mailing City:*

Mailing State:*

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware D.C. Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Mailing Zip:*

Ambassador Information: Please complete the information below to connect your name with the potential student above. NSHS will be using this information for mentoring and scholarship purposes. * Required To be an ambassador you must be eligible using one of the selections below. You CANNOT be an ambassador to yourself.

Ambassador Classification:*	---YOU MUST SELECT ONE OF THE CHOICES BELOW--- Student currently attending NSHS Student new to NSHS in the fall Student graduated from NSHS Parent of a current student at NSHS Parent of a new student to NSHS in the fall Parent of graduated student from NSHS Friend to NSHS

First Name:*

Last Name:*

Cell Number:* (999) 999-9999

Email:*

Mailing Address:*

Mailing City:*

Mailing State:*

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware D.C. Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Mailing Zip:*

Upon clicking submit button below, a copy of the information entered above will be sent to the ambassador’s email address. It is highly recommended that the ambassador keep a hard copy of this email for verification purposes.