First Name * Last Name * Address * Address 2 City/Town * ZIP/Postal Code * Employer/Organization * Employer Address Address 2 City/Town ZIP/Postal Code What is your profession? * Email * Phone * What EBMUD Ward do you reside in? Find your Ward here * 1 1 2 2 3 3 4 4 5 5 6 6 7 7 Are you available to attend ALL of the scheduled sessions? (NO response may disqualify candidate) * Yes No If No, please explain here How did you hear about the Community Water Academy Program? * District website Social media (Facebook, Instagram) Nextdoor post Word of mouth (please explain) Other (please explain) If you select Word of mouth option above, please explain here If Other, please explain here Were you referred by a current or former EBMUD employee, past Community Water Academy participant, or EBMUD Board Director? If so, please state who * Yes No If Yes, please enter name of person here Please describe your interest and explain why you would be a good candidate to consider for the academy/ambassador program. * How might your community benefit from your involvement? * What type of EBMUD topics are you most interested in learning about? * Please indicate if you are currently or have been in the past, a volunteer/member/officer/ participants/staff of any of the following types of organizations. (Check all that apply) * Local government/special district Neighborhood association Professional organizations Community groups Civic organizations Non-profit: Social Services Non-profit: Environmental Non-profit: Education & Advocacy Societies & clubs Other If Other, please explain here Please list below the organizations you are currently still involved with or connected to. * ACKNOWLEDGEMENT I am hereby applying for admission to the EBMUD Community Water Academy with the goal of becoming a Water Ambassador and relaying information to my community contacts, neighbors or constituents on matters related to EBMUD and the services they provide. If accepted I acknowledge that: I am 18 years of age or older. I reside or work within the EBMUD service area. I must be able to actively engage in all Community Water Academy sessions, to the best of my ability. It is my responsibility to notify EBMUD staff of any changes to my ability to continue participating. If selected to participate and I am unable to meet my commitment, my space in the Community Water Academy may be forfeited. Participation in the Community Water Academy is completely voluntary and unpaid. Successful completion of the Community Water Academy is required for me to be inducted as a Water Ambassador. I acknowledge that if I am accepted into the program, my name, phone number, email address, occupation, employer/organization and/or affiliations will be included in the class roster and may be shared with fellow class participants. I hereby grant full permission to EBMUD, its directors, officers, employees, and agents to capture and use photographs, videotape, motion pictures, recordings and any other media records of me for any purpose whatsoever, that such material remain the sole property of EBMUD and that I shall receive no compensation for the use of this media. A signed photo release waiver will be required at the start of the program. I affirm that the information provided in this application is complete and accurate. I recognize this is only an application and in no way guarantees admission into the EBMUD Community Water Academy. By submitting this application, I commit to fulfilling the participation and water ambassador expectations to the best of my ability and to notify EBMUD staff at education@ebmud.com should I have any questions or my availability change. Declaration * I agree to the above statement.