Admission Ambassador Information Form

Denison ID Number

How do you associate yourself with Denison?*

Current Student

Alum

Parent

Grandparent

Prefix*

First Name*

Middle Name

Last Name*

Suffix

Preferred Name

Maiden Name

Highest Degree Earned

Denison Graduation Year*

Undergraduate College/University Graduation Year*

Undergraduate College/University Name*

Undergraduate College/University CEEB Code

Occupation

Employer

Gender*

If you choose, please describe your gender identity.

If you choose, please select one or more of the following races that best describes your ethnicity:

Your High School*

Your High School CEEB Code

Contact Information

Email Address*

Cell Phone Number*

Home Phone Number

Work Phone Number

Mailing Address*

Country

Street

City

Region

Postal Code

Do you have other address we should be aware of?*

Different Permanent Address

Seasonal Address

No

Permanent Address*

Country

Street

City

Region

Postal Code

Seasonal Address*

Country

Street

City

Region

Postal Code

Seasonal Address Valid From*:

Seasonal Address Valid Until*:

Academic and Extracurricular Involvement

Which multicultural organizations were you a member of?

Were you a member of a fraternity or sorority?*

Did you study abroad?*

Did you conduct on campus research?*

Were you a member of a varsity athletic team?*

Did you work in the Office of Admission?*

Volunteer Information

Do you want to be an alumni/family ambassador for Denison?

Are you able to be an active participant in the ambassador program this year?*

Are you willing to represent Denison at a college fair this year?*

Are you willing to conduct in-person and/or virtual interviews with prospective students this year?

Are you willing to contact admitted students and their families in the spring?*

Family Information (Optional)

Do you have any relatives who attended or currently attend Denison?

Do you have a spouse/partner?

Do you have any children?

How many children do you have?

Spouse Information (Optional)

Is your spouse a Denison alum?

First Name

Last Name

Highest Degree

Undergraduate College/University

Undergraduate College/University School Code

Undergraduate College/University Graduation Year

Undergraduate College/University

Undergraduate College/University School Code

Undergraduate College/University Graduation Year

Child 1 Information (Optional)

First Name

Last Name

Birthdate

What is the highest level of education this child has completed or is currently attending?

High School

High School CEEB Code

High School Graduation/Anticipated Graduation Year

Did/Does this child attend Denison?

Undergraduate College/University

Undergraduate College/University School Code

Undergraduate College/University Graduation/Anticipated Graduation Year

Undergraduate College/University

Undergraduate College/University School Code

Undergraduate College/University Graduation/Anticipated Graduation Year

Child 2 Information (Optional)

First Name

Last Name

Birthdate

What is the highest level of education this child has completed or is currently attending?

High School

High School CEEB Code

High School Graduation/Anticipated Graduation Year

Did/Does this child attend Denison?

Undergraduate College/University

Undergraduate College/University School Code

Undergraduate College/University Graduation/Anticipated Graduation Year

Undergraduate College/University

Undergraduate College/University School Code

Undergraduate College/University Graduation/Anticipated Graduation Year

Child 3 Information (Optional)

First Name

Last Name

Birthdate

What is the highest level of education this child has completed or is currently attending?

High School

High School CEEB Code

High School Graduation/Anticipated Graduation Year

Did/Does this child attend Denison?

Undergraduate College/University

Undergraduate College/University School Code

Undergraduate College/University Graduation/Anticipated Graduation Year

Undergraduate College/University

Undergraduate College/University School Code

Undergraduate College/University Graduation/Anticipated Graduation Year

Child 4 Information (Optional)

First Name

Last Name

Birthdate

What is the highest level of education this child has completed or is currently attending?

High School

High School CEEB Code

High School Graduation/Anticipated Graduation Year

Did/Does this child attend Denison?

Undergraduate College/University

Undergraduate College/University School Code

Undergraduate College/University Graduation/Anticipated Graduation Year

Undergraduate College/University

Undergraduate College/University School Code

Undergraduate College/University Graduation/Anticipated Graduation Year

Child 5 Information (Optional)

First Name

Last Name

Birthdate

What is the highest level of education this child has completed or is currently attending?

High School

High School CEEB Code

High School Graduation/Anticipated Graduation Year

Did/Does this child attend Denison?

Undergraduate College/University

Undergraduate College/University School Code

Undergraduate College/University Graduation/Anticipated Graduation Year

Undergraduate College/University

Undergraduate College/University School Code

Undergraduate College/University Graduation/Anticipated Graduation Year

I acknowledge that all information regarding student's information, applications and status is confidential and I, hereby, will only use this information for the purposes outlined for outreach and communication regarding Denison University admission.

Agree