Basic Information

Welcome to the Nightline Ambassador Application form. Nightline Ambassadors are responsible for promoting Nightline in their respective university campus. This form consists of **3 pages** and will take about 10 minutes for you to complete. Thank you for your interest in being an Ambassador!

Please fill out this first page with your basic information. We will use your contact details to contact you about your application, so please enter them carefully! We will be holding two training sessions on the 13th and the 15th of November, so please keep one of the dates free to attend it! 

The deadline for submitting this application is at 10pm on the 6th of November 2017.

* 1. Your Contact Information

* 3. (if applicable) Campus/School within University

* 4. Year of Study

* 5. Degree / Course Title

* 6. Age

* 7. Where did you hear about the Nightline Ambassador Program?