Ambassadorship Nomination Form

Since 1976, Junior Chamber International (JCI) chapters in every state have recognized their finest members by presenting them with the prestigious Ambassador honor. This life-long honor recognized those who have served JCI USA and their community with highest distinction and greatest contribution. Recognize that special Jaycee for their outstanding service, involvement, and commitment by nominating them as an Ambassador - the highest honor bestowed on a Jaycee in the United States.

Your Name(Required)

First Last

Your Email(Required)

Ambassador Honoree Information

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Date of Birth(Required)

Date Joined JCI USA Chapter(Required)

Before receiving an Ambassadorship, the individual must be an active member of JCI USA for at least three years. Check the box below to certify:(Required)

The individual I am nominating for an Ambassadorship has been an active member of JCI USA for 3 years or more.

Positions held (please list all positions and year(s) served):(Required)

Honors received (please list all awards/honors and year received):(Required)

Why do you feel this nominee deserves an Ambassadorship?(Required)

Any additional documentation you wish to submit (optional)

Drop files here or

Max. file size: 128 MB.

Presentation Information

Date of Formal Presentation(Required)

Date Award is Needed(Required)

Please send nominations no later than four weeks before the award needed date. If honor is to be sent to anyone other than the nominee, please provide the information below:

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Phone

Approvals

After submitting this form, a copy will be sent to the honoree's Chapter President & State President for approval, followed by the JCI USA National President & Executive Director.

If the Ambassador honoree is the current President of either of these roles, do not list them in the section below. Instead, submit the name & email of the next senior officer, so that they may sign off on the application.

Is the honoree's local chapter currently active?(Required)

Yes

Name of Ambassador Honoree’s Local Chapter/Organization:(Required)

Name: Local Chapter/Organization President(Required)

First Last

Email: Local Chapter/Organization President(Required)

Is the honoree's state organization currently active?(Required)

Yes

Name of Ambassador Honoree’s State Chapter/Organization:(Required)

Name: State President(Required)

First Last

Email: State President(Required)

Payment Options

For expedited processing, we recommend sending this form and payment electronically.
To pay the ambassador application payment and submit application, please click below.
Make a Payment

Upload Proof of Payment(Required)

Max. file size: 128 MB.

For a printable PDF copy of this form, please click here. Submitting the application and payment through the digital form above is encouraged for a faster approval process.