Become an Ambassador! | Amachi Pittsburgh

Want to Become an Ambassador?

WANT TO BECOME AN AMBASSADOR?!

You can complete an intake form below through our secure website, which will be sent automatically to our Amachi Program Coordinator, Kristina. Your information will be kept completely confidential.

If you have any questions, feel free to contact Kristina at (412) 281-1288, option 5.

NOTE: If you do not receive a "Thank You" message after submitting, your application was not submitted successfully. Please notify Kristina immediately.

Ambassador Contact Information

Parent/Guardian/Caregiver Information

Personal/Demographic Information

Which family member(s) has ever been behind bars at any time in your life? *

(Includes adoptive, in-law and step family members)

Mother
Father
Grandparent
Sibling
Cousin
Aunt
Uncle

School Information

Your Extra-Curricular Activities & Hobbies

Briefly tell us why you want to become an Ambassador * Help Text

(In 50 words or less)

Person submitting this form: *

Self (teen)
Parent/Guardian
Teacher/Counselor
Community member referring a teen