Western Alumni Ambassador Interest Form

Thank you for your interest in being an ambassador with Western Alumni. Please complete the form below with your contact information and some additional questions. Please note that some applicants might be re-directed to other engagement opportunities.

For more information, please review the Western Alumni Ambassador Role Description or visit the Western Alumni Global Ambassador Program web page.

Please tell us who you are

Title

First Name Do you have a preferred name?

Middle Name

Last Name

Name while attending Western

Student or Alumni Number
Where can I find my alumni number?

- OR -

Degree

Graduation Year

Home Address

Street Address 1

Street Address 2

City

Province/State

Country/Region

Postal/Zip Code

Home Phone
Numbers only (eg. 5195551234)

Mobile Phone
Numbers only (eg. 5195551234)

Work Address

Position Title

Company Name

Social Media

Twitter Handle

Facebook Username

Instagram Username

LinkedIn URL

WeChat ID

Were you involved with any clubs or athletics while you were a student at Western?

Yes No

Have you attended any Western Alumni events in the past?

Yes No

Why are you interested in volunteering with Western Alumni?

After reading the role description, are you confident that you will be able to commit your time and talent as an ambassador?

Yes No

The information provided above will be used to update your Western alumni record. Please read Western's Privacy Policy if you wish to learn about how the University protects and uses your information.

Western Alumni is committed to employment equity and diversity and welcomes applications from women, members of racialized groups/visible minorities, Aboriginal persons, persons with disabilities, persons of any sexual orientation, and persons of any gender identity or gender expression.

Western University, Department of Alumni Relations & Development
Westminster Hall, Suite 110
London, Ontario, Canada, N6A 3K7
Toll-free: 1-800-258-6896
alumni@uwo.ca