Student Ambassador Interest Form: Music and Brain Health Initiative

First name

Last name

Email

School Name

If "Other", list school level and affiliation here:

City/State and Neighborhood

Do You Have Experience with Music?

Instrumental (please specify below)

Vocal

Both

No formal experience

Have you worked with seniors or in community service before?

Yes

No

If yes, briefly describe your experience

How would you like to be involved?

Performing music for seniors

Organizing or coordinating events

Conducting interviews (podcast/project)

Researching music and brain health

Outreach / awareness efforts

Other (please specify)

If "Other", please specify

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