OPMAB Ambassador Application Form

Ambassador Program Application Form
Please complete all sections of the following form to be considered for the Oregon Project Management Advisory Board's Ambassador Program. Completed applications must identify a Sponsoring Manager who will be contacted to confirm their support of your participation in the Program.
I. Personal Data:

Tell us about yourself
Full Name : *

First Name Last Name
Mobile No. : *

Area Code Phone Number
E-mail : *
Where the confirmation will be sent
Agency/Employer Name : *
Work Address : *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Project Management-related Professional Certifications you hold: *
Years of Project Management Experience: *
II. Oregon Project Management Certification Program Cohort Information:
Please provide your cohort number: *
Have you passed all OPMCP assessments so far? *

Yes No
When is your anticipated graduation date? *

Month Day Year
Date
III. Application Questions:
Please tell us why you are interested in the Ambassador Program: *

0/500
What strengths and skills will you contribute to the Oregon Project Management Board's work? *

0/500
What ideas and projects would you propose to take on during your ambassadorship? *

0/500
What specific goals would you set for your six months with the Board? *

0/500
How does this opportunity align with your career goals? *

0/500
IV. Sponsoring Manager Information
Sponsoring Manager Name : *

First Name Last Name
Sponsoring Manager Title: *
Sponsoring Manager Phone No. : *

Area Code Phone Number
Sponsoring Manager E-mail : *
Where the confirmation will be sent
I have discussed this opportunity with my Sponsoring Manager, and they support my participation in the Program:

Yes
V. Applicant's E-Signature
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
E-Signature: *
Should be Empty:

Ambassador Program Application Form

I. Personal Data:

II. Oregon Project Management Certification Program Cohort Information:

III. Application Questions:

IV. Sponsoring Manager Information

V. Applicant's E-Signature