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Local Coordinator Background Check Form
Please submit the following background form to complete the next step in becoming a Local Coordinator for Student Ambassador Exchange. If you are interested in becoming a Local Coordinator but have not yet applied, you can do so here > http://studentambassadorexchange.org/about/local-coordinator/
If you have difficulty with this form or questions you can contact us toll-free at 1-888-493-2645 or at 512-323-9595 ext.3052 & ext. 3053 or email us at email@example.com.
Date of Birth*
Have you been convicted of a crime?*YesNoIf yes, please explain.Were You Referred to our Program?*YesNoPlease enter your referring LC or staff's name:Are you interested in being a Local Coordinator working with high school students coming for a school year or semester?*
Are you interested in being a Short-Term Local Coordinator working with high school students and adults coming for internship programs?*
Would you be willing to host if needed?*
Please include any additional relevant information.
By signing this form, you understand that this is an independent contractor position and earnings are commission based. You consent to SAE running a background check for the purpose of ensuring the safety of its students. SAE respects and recognizes your privacy and will not distribute information collected in this form for any other purpose other than relating to SAE and its operation.Electronic Signature*