Local Way Ambassador Application – The Way International Forms

{Interviewer Name (First):96.3} {Interviewer Name (Last):96.6} recommends {Name (First):7.3} {Name (Last):7.6} as a {Program Type:90} Way Ambassador.

{Interviewer Name (First):96.3} {Interviewer Name (Last):96.6} does not recommend {Name (First):7.3} {Name (Last):7.6} as a {Program Type:90} Way Ambassador.

State coordinator/Cabinet recommends {Name (First):7.3} {Name (Last):7.6} as a {Program Type:90} Way Ambassador.

State coordinator/Cabinet does not recommend {Name (First):7.3} {Name (Last):7.6} as a {Program Type:90} Way Ambassador.

WUSA approved {Name (First):7.3} {Name (Last):7.6} as a {Program Type:90} Way Ambassador.

WUSA rejected {Name (First):7.3} {Name (Last):7.6} as a {Program Type:90} Way Ambassador.

Home Fellowship State*

Branch Coordinator Name*

First Last

Personal Information

Class Requirements

I am a graduate of the Intermediate Class

Name*

First Middle Last

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Phone Number*

Email*

Sex*

Male

Female

Date of Birth*

Month

Day

Year

Name Wanted on Nametag*

First Last

Name Wanted on Certificate*

Please enter full name to be used.

Where have you lived most of your life?*

Which state?*

For how many years?*

Please enter a number greater than or equal to 1.

T-Shirt Size*

Emergency Contact Information

Emergency Contact Name*

First Last

Emergency Contact Address*

Street Address Address Line 2 City State ZIP Code

Emergency Contact Phone Number*

Relationship to Applicant*

Marital Status and Spouse Information

Present Marital Status*

Single

Married

Wedding Date*

Month

Day

Year

Spouse’s Name*

Maiden Name*

Children Information

Number of Children with You*

Only put on one parent’s form.

Please enter a number greater than or equal to 0.

Children Information

Name	Date of Birth	Age at Beginning of Training	School Grade During Way Ambassador	T-Shirt Size	Actions

There are no Children.

Health and Medical Information

Do you have any limitations, special health needs, and/or dietary restrictions (gluten-free, vegan, etc.)?*

Yes

Please specify these limitations, health needs, and/or dietary restrictions.*

Are you taking medications or required supplements?*

Yes

Please specify. What kinds of medications or supplements? What do they do?*

Do you have a 9-month supply of these medications or supplements? If not, do you have the funds to purchase a 9-month supply?*

Yes

Please add any other comments.

Vehicle Information

Are you taking a vehicle?*

Yes

Photo of Driver’s License*

Drop files here or

Max. file size: 128 MB, Max. files: 1.

Photo of Vehicle Insurance Card*

Drop files here or

Max. file size: 128 MB, Max. files: 1.

Vehicle Make*

Vehicle Model*

Vehicle Year*

Vehicle Condition*

Passenger Capacity*

Please enter a number greater than or equal to 1.

Please upload a photo of yourself. If you are bringing children, please upload a photo of your family.*

Drop files here or

Accepted file types: jpg, jpeg, png, gif, tif, tiff, bmp, webp, Max. file size: 20 MB, Max. files: 1.

Signature*