Nurse Ambassador Application Form

The Nurse Ambassador Program is a volunteer program consisting of Registered Nurses across Ontario who donate their time, knowledge and experience by discussing and presenting the nursing profession at various community events, career fairs and speaking engagements in schools – with audiences ranging in education from high school students to mature students .

Nurse Ambassadors share information about the nursing profession to assist and prepare those who are considering nursing as a career.

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First Name: *

Last Name: *

Email: *

Address: *

City: *

Postal Code: *

Telephone Number: *

Work Title/Position:

Organization:

Please select your highest level of education: *

Please select the number of years nursing experience below: *

Please rate your comfort level in presenting/public speaking in the following formats: *

	Not comfortable at all	Somewhat comfortable	Comfortable	Very comfortable	Completely comfortable
Small Group (10-20 People) *	Small Group (10-20 People) - Not comfortable at all	Small Group (10-20 People) - Somewhat comfortable	Small Group (10-20 People) - Comfortable	Small Group (10-20 People) - Very comfortable	Small Group (10-20 People) - Completely comfortable
Large Group (20+ people) *	Large Group (20+ people) - Not comfortable at all	Large Group (20+ people) - Somewhat comfortable	Large Group (20+ people) - Comfortable	Large Group (20+ people) - Very comfortable	Large Group (20+ people) - Completely comfortable
Expo/Career Fairs (Managing an exhibit or booth where a range of questions may be asked) *	Expo/Career Fairs (Managing an exhibit or booth where a range of questions may be asked) - Not comfortable at all	Expo/Career Fairs (Managing an exhibit or booth where a range of questions may be asked) - Somewhat comfortable	Expo/Career Fairs (Managing an exhibit or booth where a range of questions may be asked) - Comfortable	Expo/Career Fairs (Managing an exhibit or booth where a range of questions may be asked) - Very comfortable	Expo/Career Fairs (Managing an exhibit or booth where a range of questions may be asked) - Completely comfortable

Please rate your experience in public speaking (groups greater than 10 people) using the scale below: *