The Gerontological Society of America

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Campus Ambassadors Application

GSA ESPO
Campus Ambassador Application

Applicant: Along with this form, please send a cover letter detailing some of your intentions for your Campus Ambassador Program, the type of resources that will be available to you, and the reasons for your interest in participating. Also, please enclose a membership application if you are joining GSA. Click here to become a member online or download the paper membership application.

These materials can be sent to:

Campus Ambassador Program
The Gerontological Society of America
Attn: Robert Burleson
1220 L Street, NW
Suite 901
Washington, D.C. 20005

If you are planning on applying with another student to serve as co-Campus Ambassadors, you should both submit this form independently. Please enter your co-Ambassador's name here:

If you are applying with the support of a Faculty Advisor, please have them fill out the Faculty Advisor Application (here) and include it with your materials. Name of Faculty Advisor:

Date:
Name:
Degree:
Date Degree Expected:
Name of Institution/
College/University:
School/Department/
Program:
Address:
City:     State/Province:
Zip/Postal Code:       Country:
Phone:       Fax:
E-mail:

I am a student member in good standing of The Gerontological Society of America and wish to be considered as a candidate for the GSA Emerging Scholar and Professional Organization (ESPO) Campus Ambassador Program for the above-named institution. I am willing to make a commitment to serve in this capacity for a period of one year. I also consent to having my name, institution and e-mail address posted on the GSA website.

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