Aging and Youth Services Department
My Brother’s Keeper Fulton County
Ambassador Application

Section I – Student Information

Emergency Contact Information

Section II – Parent/Guardian Contact Information

Section III – Parent/Guardian Dependent Information

Section IV – Parent/Guardian Eligibility Criteria

You will be asked to provide the following information (possibly official documents) as a condition of admission into the My Brother’s Keeper Fulton County Program:
Birth Certificates
Social Security Cards
Letter from TANF
Income Verification
School Registration
Proof of Residency

MBK Fulton County Youth Ambassadors Essay
In 500 words or less, explain why you should be a member of My Brother’s Keeper Fulton County Youth Ambassadors.

I certify that my answers on this application are true & complete and that I have not knowingly withheld any information that might, if disclosed, affect my application unfavorably. I understand that any misrepresentation or omission of facts on this application could be cause for rejection of this application or dismissal.

I understand that after I submit my application, it will be reviewed and my eligibility for the My Brother’s Keeper Fulton County program will be determined. I agree to attending orientations and meeting as a part of my admission into the program.

I hereby Release and Waive liability against Fulton County Government, their partners, its directors, officers, employees and agents, its successors and assigns, for any injuries or illness that I myself or my dependent may suffer in connection with any activities during Programs offered via Fulton County’s Aging and Youth Services Departments Office of Children and Youth. Further, I agree that the aforementioned, is not liable for any damage to my property.