Ambassador Program Application - The Arc of Lehigh and Northampton Counties

Ambassador Email(Required)

Ambassador Phone(Required)

Is the Ambassador 18 years or older?(Required)

Ambassador Date of Birth

Does the Ambassador have a Guardian and/or Power of Attorney?

Guardian/POA Email

Guardian/POA Phone

Are you completing this form for yourself or someone else?

Your Email

Your Phone

Are you and/or the Ambassador applicant familiar with any of The Arc's programs or services?