Choose Nursing: Ambassador for Nursing Resource Center

What Do I Need to Do?

Why Do We Need Your Stats & Facts?

Presentation Tools

Presentaciónes en Español

Stats & Facts Form

Please complete ALL of the fields so we can mail you your Ambassador for Nursing pin.

Your Name:

Email Address:

US Mail Address:
Street:
City:
Zip Code:

Area Code: Phone Number:

Describe your Presentation.
Which presentation tool(s) did you use?
(you must check at least one)

elementary	middle school
high school/young adult	none
other (please describe)

On what date did you give your presentation? (mm/dd/yy)
/ /

Location Name:

Location Type:

Location Type other than listed above?

Location Zip Code:

Describe your audience:
How many young people attended:

Please tell us the ethnic makeup in approximate percentages.
This information is required by our sponsors.
% African American
% Hispanic
% Asian
% Caucasian
% Native American

What age group was your audience?

Please double check to be sure that your entry form is complete before sending.

We hope you enjoyed your experience as an Ambassador for Nursing. We thank you enormously!


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