Form PC-2175 Campus Ambassadors Onboarding Form

Campus Ambassador Onboarding Form Questions

Audience: Campus Ambassadors

Timeframe for form release: After potential Campus Ambassadors express their interest.

Welcome to the Peace Corps Campus Ambassador Program. The work you do at your college or university helps us spread the word about the Peace Corps throughout the country!

By submitting this form, you are confirming your interest in participating in the Campus Ambassador Program for the next Academic Year. If you need a paper form, please contact The Office of University Programs, Peace Corps, 1275 First Street NE, Washington, DC 20526, or email: ambassadors@peacecorps.gov

• Legal name (first and last)

• What university or college will you be attending during the next Academic Year?

• When does your school year begin?

  • [Provide date]

We have a package we want to send you with a t-shirt, swag, and Campus Ambassador materials.

• Please provide your mailing address you use during the school year:

  • Street number

  • Street name

  • Building name (if applicable)

  • Apartment number (if applicable)

  • City

  • State

  • Zip code

  • Country

• What is your t-shirt size? T-shirt sizes are unisex.

  • Small

  • Medium

  • Large

  • XL

  • XXL

  • Other

Paperwork Reduction Act Statement

Public reporting burden for this information collection is estimated to average10 minutes. This includes the time for reviewing instructions and completing the questions. This is a voluntary information collection. An agency may not conduct or sponsor, and persons are not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: the FOIA Officer, Peace Corps, 1275 First Street NE, Washington, DC 20526. E-mail suggestions to: pcfr@peacecorps.gov

Campus Ambassadors Onboarding Form – Privacy Act Statement

The Peace Corps, an agency of the federal government, is required by the Privacy Act of 1974, 5 U.S.C. 552a (The Privacy Act) to advise you of the following information regarding this form. The Peace Corps follows the requirements of the Privacy Act which protects personal identifiable information that the agency maintains and uses in its systems of records (SORs).

Authority: The Peace Corps Act, 22 U.S. Code § 2501.

Purpose: The purpose of this form is to confirm your interest in participating in the Campus Ambassador Program for the next Academic Year.

Routine Uses: Use of the information collected based on this form is restricted to the purposes cited in this privacy statement or unless the disclosure is otherwise permitted under the provisions of the Privacy Act of 1974, and the agency’s privacy policy. The information you provide may be used for the routine uses described in the Privacy Act, and the Peace Corps' published System of Records Notices, PC-17, Peace Corps Volunteer Applicant and Service Records System and PC-18, Former Peace Corps Volunteers and Staff Database.

Disclosure: The information you provide is voluntary. However, failure to provide complete information and to submit this form may slow down the selection process, and will eventually disqualify you from being selected as a Campus Ambassador for the Peace Corps. The agency is committed to ensuring that any personal information it receives is safeguarded against unauthorized disclosure.