Student Ambassador Application

Thank you for your interest in the Development & Alumni Relations Student Ambassador Program. Please complete the form below. The deadline to apply is August 31, 2025. Notifications of acceptance will be sent out the week of September 7.

Name Name * Title First Last Suffix
Nickname/Preferred Name if different from first name
Email *
Local address Local address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Best contact phone number Best contact phone number * - ### - ### ####
Date of Birth Date of Birth / MM / DD YYYY
Gender

Gender Male Female Non-Binary Transgender Other Prefer not to answer
Ethnicity

Ethnicity American Indian/Alaska Native Asian Black /African American Hispanic/Latino Native Hawaiian/Other Pacific White Prefer not to answer
Hometown *

Example: Norfolk, VA
Program (MD, Medical Masters, PA, SA, etc.) *
Did you receive an EVMS scholarship? *

Did you receive an EVMS scholarship? Yes No
List EVMS scholarships (if applicable)
List any other scholarships, if received
Undergraduate College/University *
Undergraduate degree (Ex. Bachelor of Science, Chemistry) *
Graduation year *
Please list any additional degrees earned, the institution earned from, and the year obtained. (i.e., Master's in Biomedical Sciences at Eastern Virginia Medical School, 2022)
Tee shirt size
Why do you want to be a student ambassador? *
Why did you decide to go into the medical and health professions field? *
Why did you choose to attend this institution? *
What Medical Specialty or healthcare focus area are you currently interested in pursuing? *
Given your time here to date, what is your favorite thing about the institution?
What clubs/organizations do you plan to join or are currently a member of?
Do you have any additional activities/hobbies?
Please share a brief biography about you to include any EVMS clubs/organizations of which you are a member, any honors/awards received since college, any community service/volunteer activities since college, etc. (See below for a sample) *
Sample biography

Kevin is a member of the MD Class of 2023. Kevin serves as the AAMC representative and Choosing Wisely STARS representative for his class and has served his class as a course representative for Human Anatomy. Kevin's passion for medical care started from when his close family member was diagnosed with cancer and he witnessed the challenges they faced in managing the disease. He has a strong interest in working with the under served population upon completion of his medical degree.

Student Ambassador Application

Student Ambassador Application

Sample biography