Form Section 1

Junior Water Ambassadors Academy Application

Palmdale Water District (PWD) is hosting its first Junior Water Ambassadors Academy to give interested high school students the opportunity to learn about PWD’s history, infrastructure, facilities, water sources, and future projects.

The goal of this new program is to engage and educate the youth in the Antelope Valley about our current water portfolioa, and the future of water and jobs in the industry.

Applicants selected for the program must commit to the scheduled session. There are no fees, tuition or charges to participate in the Jr. Water Ambassadors Academy. Space is limited. Applicants must be a sophomore or junior in high school and have permission from a parent / guardian to participate.

If you would like more information, please contact Public Affairs Specialist Larua Gallegos at lgallegos@palmdalewater.org or 661-441-5944.

The deadline to submit is April 12, 2019.

Last Name

First Name

Middle Initial (Optional)

Address Autocomplete

Enter an address

Street Address Street Name

Apt, Suite, etc

City

State

Zip Code

Country

Phone Number

What grade are you in?

10th

11th

Name of School

Please list any dietary restrictions. Lunch will be provided.

Recommended / Nominated by (self is okay)

How did you hear about the academy?

Palmdale Water District Board Member or Employee

Academy Graduate

Local Group

Social Media

Friend or Family Member

School District

Other (Please indicate)

Why are you a good candidate for the Jr. Water Ambassadors Academy? Please include what you would like to learn and share.

Extracurricular Activities

Preferred Name for Name Tag

Acknowledgement

I acknowledge that if I am accepted into the program I must commit to the scheduled sessions and my name, phone number, email address and school information will be included in the class roster and shared with fellow participants.

Parent / Guardian Permission

Yes

Parent / Guardian Signature / Initials

First Name

Last Name

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.