Personal Information
First Name (as it appears on your ID)
Last Name
(as it appears on your ID)
Lived First Name
Pronouns
UC Berkeley Email
Non Berkeley Email
Phone
SID
Birthday
What languages do you speak in addition to English?
Racial or Ethnic Identity
Racial or Ethnic Identity
Please select...
American Indian/Alaskan Native
Bi-Ethnic or Multi-ethnic
African/African-American
Asian/Asian-American
Chican@/Latin@
White
Pacific Islander
I do not identify with the above options
Decline to State
If you selected “I do not identify with the above options”, or would like to provide details about your race/ethnicity, please do so in the field below.
Gender Identity
Gender (select all that apply):
Woman
Man
Transgender
Nonbinary
Other
Decline to State
If you selected Other or would like to provide more details about your gender identity, please do so in the field below.
Residency Information
What is your residential status?
Please select...
In State
Out of State
International
Hometown
Please indicate whether you live in the Residence Hall, a co-op or are a member of a Fraternity or Sorority.
Please select...
COOP
Fraternity/Sorority
Residence Hall
Not Applicable
What will be your Fall address (if known)?
Educational Information
Are you a transfer student?
Please select...
No
Yes-incoming transfer: will be my first semester
Yes-returning: won't be my first semester
Expected Graduation Year
What is your major?
Are you a first-generation college student, meaning your parents, guardians, or grandparents did not attend college?
Please select...
Yes
No
Program Information
Have you participated in any other Public Service Center programs? If so, please select which ones. (check all that apply)
Alternative Breaks
Bridging Berkeley
BUILD
Cal in the Capital
College Corps
Community Projects Leader
CREATE
Public Service Internship Program
Residential Service Initiative
Volunteer Income Tax Assistance (VITA)
What other internship or leadership programs are you applying to for next year?
Please list any dietary preferences, needs or allergies you may have.
I have confirmed the requirements of the Andrew Goodman Vote Everywhere Ambassador role.
Please select...
Yes
No
Other
If you selected "Other", please explain the reason you can not fulfill the above requirements.
Short Answer Questions
1.
Why are you applying for a position as a an Andrew Goodman Vote Everywhere Ambassador? Share two relevant skills and give examples of how you applied these skills in the past. (Please limit your response to 400 words.)
2.
Describe your leadership style. (Please limit your response to 200 words.)
3. How do you see yourself living into the PSC values of Social Justice and Equity? (Please limit your response to 200 words.)
Resume
Please upload your resume.
More Information
Application Information is Correct:
The information in this application is true to the best of my knowledge.
How did you hear about this program?
Would you like to receive a monthly email of service and leadership opportunities, scholarships, and more?
Yes
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