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YOUTH AMBASSADORS
Program Application

A youth program for students in grades 10 12

The Arts Can Take You Places!

INSTRUCTIONS
Please print legibly using blue or black ink.

APPLICANT INFORMATION

Name: Last:_____________________________ First:____________________________ M.I.____
Date of Birth: ___________________________ Age: ________
Country of Birth: ______________________________
Address: _______________________________________________________________
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City: ___________________________________ State: ________________ Zip-Code: ___________
Phone #: (_______) ________ - _________
Cell #: (_______) _______- ____________
E-Mail: _____________________________
What language, other than English, is spoken in your home? _________________________
How did you hear about the program? ______________________________

SCHOOL INFORMATION

School Name: _________________________________________________

Address: ________________________________________________
Ward (if applicable) ____________
Current Grade: _____________ Grade in 2014-15:_____________

Parent/ Guardian Information

Name: Last:__________________________________ First:________________________
Is address same as above? ___________
If no, fill out below:
Street: __________________________________________________________________________
City: ___________________________________ State: __________ Zip Code: ________________
Phone # : (_______) _________ - _________
Cell # : (_______) ________- __________

Emergency Contact: ________________________________________________________

Relationship: ______________________ Phone: ________________

Note: Parents or guardians must complete and sign a Consent Form which includes permission for
participants to be photographed for educational, archival, and public relations purposes for this
program.
An interview is schedule with the applicant only after the National Museum of African Art, Museum
Education Office, has received the completed application.

ESSAY

Write a short essay on a recent museum visit you enjoyed. Choose your favorite exhibition and
describe it. Include the title of the exhibition, theme, what objects and/or other materials
comprised the installation (light/sound/videos/inter-actives, other). Discuss what specifically
caught your interest and why. What did you learn from this experience? While writing, imagine
you are talking to a friend!

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SHORT RESPONSE QUESTIONS

1. Why do you want to be a National Museum of African Art Youth Ambassador?
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2. Please list all organizations or clubs at school of which you are a member.
Name of Club

Position

Year(s)

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3. How many hours can you commit to NMAfA

Per week: 2____ 3_____ 4_____ Other _____
Per Month: 2____ 3_____ 4_____ Other _____
Weekends: Yes _____ No _____

RECOMMENDATION
For the Smithsonians National Museum of African Art
TEEN AMBASSADORS PROGRAM
(To be completed by a teacher)
Name of student: ________________________________________________________
Name of teacher: ________________________________________________________
I have known the applicant for: _____________________________________________
Please evaluate the student. How would you describe this applicants academic work habits?
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In your opinion, what are the most outstanding characteristics of this applicant?
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Additional Comments:
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Signature _______________________________________

Date _________________________Telephone # __________________________

DEADLINE FOR APPLICATION: August 15, 2014

Completed Questions
Essay and Short Responses
Completed Teacher Recommendation
Most Recent Report Card

Return to:
Deborah Stokes, Curator for Education
Smithsonian Institution
National Museum of African Art
950 Independence Ave. S.W.
MRC 708 PO 37012
Washington, D.C. 20013-7012
Email: StokesD@si.edu
Fax: (202) 3574879

For more information regarding our Youth Ambassador ,
please contact Ms. Deborah Stokes at StokesD@si.edu or (202) 633-4632.


Visit our Website at: africa.si.edu