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Colorado Chapter Ambassador Program
Application information and form
Overview of the Program
History
Since 1946, the March of Dimes has identified a child to represent the organization to the American public, developing what became known as its “poster child.” During the foundation’s polio campaign, the poster child was stricken with polio.
Our program today
Today, the ambassador program is an annual campaign that puts a face on the March of Dimes mission and spotlights a child (born prematurely or with a birth defect or other health challenge) who was helped by March of Dimes-funded research, services, advocacy or educational programs. The ambassador and his family (together known as the ambassador family) play a vital role in promoting the March of Dimes mission to give every baby a healthy start. The March of Dimes is a diverse organization and we strive to make sure the ambassador and his family represent the communities we serve.
Throughout the year, the ambassador family commits to travelling within their community to corporate meetings, special events, conferences and fundraising activities to share their compelling story with audiences. During March for Babies season (mid-January through May) there is an intense schedule with many commitments, some last-minute. During these visits, the ambassadors meet with senior-level corporate management, corporate teams, corporate sponsors, March for Babies leaders, government officials and are available for media interviews and photo sessions–all to increase visibility of the March of Dimes and its mission. In addition, the ambassador family allows their story and photos to be featured in numerous chapter-generated communications, including collaterals, emails and websites. The ambassador family also serves as a role model for other supporters by raising much-needed funds for March of Dimes programs.
Depending on the situation, more than one ambassador family per community may be chosen for any given year.
Selection Process
Qualifications for candidates
The following guidelines will be used to qualify candidates for a Colorado chapter ambassador. Ambassadors will be selected for one-year terms (January–December) for the following communities: Boulder, Colorado Springs, Denver, Grand Junction, Greeley, Larimer County and Pueblo. (Ambassadors from time to time may be asked to travel to other communities to serve as representatives and spokespeople there.)
§ The March of Dimes must have played some role (through research, services, advocacy and/or education) in the child’s story–and both the parents and the child must be able to articulate this.
§ The child’s school schedule and the work schedule(s) of the parent(s) must be flexible enough to accommodate appearances without jeopardizing either the child or the parent.
§ The child should have a basic understanding of his story and be able to say a few words about it. The child and his parent(s) must be able to represent the March of Dimes.
§ The child should be between the ages four and seven.
§ The child must be healthy enough to handle a fairly rigorous schedule that may include early mornings and late nights.
§ Ambassador families commit to fundraising goals and collect donations through their March for Babies family team.
§ Interested families must submit an application by the deadline. If chosen, they must undergo training and allow for continued coaching throughout their term.
§ Interested families must submit photos (no more than 10, in digital JPG form) that chronicle their story from the birth of the ambassador child to now. At least one photo must be a family photo.
Ideally, an ambassador child would have these characteristics:
§ Comfortable meeting new people.
§ Talkative.
§ Enjoys having his picture taken.
§ Follows direction well, from his parents and other adults.
§ Well-mannered.
The parents of ambassador children also need qualities essential for the role. They include:
§ Being able to articulate the March of Dimes mission in a simple yet impactful way.
§ Comfortable being scripted.
§ Open to direction and coaching.
Review and selection process
The chapter office must receive application forms by Thursday, October 13, 2011. Applications will be reviewed by a panel of March of Dimes Colorado chapter volunteers and staff. Top candidates may be asked to meet in person with (as appropriate) members of the March of Dimes panel to talk informally about the role and the ambassador child’s story. Applicants selected for the role will be notified by phone on Thursday, December 1, 2011. Selected ambassador families will undergo a background check, standard for many March of Dimes volunteer roles. Applicants not selected will also be notified on Thursday, December 1, 2011. The March of Dimes may still wish to use their story and photos for collaterals, emails and websites and will ask permission then. Applicants not selected for any given year can apply again. Former ambassadors cannot apply again, but can (and are very much encouraged to) remain active volunteers. Their stories and photos remain in the chapter’s archives and may continue to be utilized for marketing and awareness-building purposes. They may be asked to serve as representatives and spokespeople in certain situations.
Training
The ambassador and his family are provided with training by chapter staff to ensure that they feel comfortable with their role and can be positive representatives of the March of Dimes mission. The training will incorporate best practices for public speaking, media relations and corporate visits. The emphasis will be on effective delivery of the March of Dimes mission and audience call-to-action, as they relate to the ambassador family’s story. Background and training on sensitive issues will also be provided. To aid in training, the March of Dimes will provide general and local mission information and a calendar of local events.
Moving forward
Ambassador families will be assigned a local staff person who will serve as their point of contact during the year. It is with this person that local appearances will be scheduled and managed.
Timeline for 2012 candidates
Thursday, September 1, 2011
Application information and form available at marchofdimes.com/colorado
Thursday, October 13, 2011
Applications due from interested families
Thursday, December 1, 2011
2012 selected ambassador families and other applicants notified
Monday, December 5, 2011
Training scheduled
First half – January 2012
Training conducted
For more information
If you have questions, or would like more information about the Colorado chapter ambassador program, please contact Becky Herlinger at 303-692-0011 or .
Colorado Chapter Ambassador
Application Form
Please save this application information and form to your computer, type in all responses and
return as one single document.
Candidate information
Date of application: ______
Desired community: ______
(Boulder, Colorado Springs, Denver, Grand Junction,
Greeley, Larimer County, Pueblo)
Name of child
Age Date of birth
Home address City State Zip
Home phone
City of birth Due date Birth weight Length
Length of NICU stay Cost of NICU stay
Name of school Grade level
School address City State Zip
Interests and activities
Was the child born via a scheduled c-section or labor induction? Yes No
Are the child candidates multiples? If so, please provide additional information below.
Were the children natural multiples? Yes No
Name of child
Age Date of birth
Home address City State Zip
Home phone
City of birth Due date Birth weight Length
Length of NICU stay Cost of NICU stay
Name of school Grade level
School address City State Zip
Interests and activities
Was the child born via a scheduled c-section or labor induction? Yes No
Family information
Parent’s name
Date of birth Age Occupation
Business address City State Zip
Business phone Business fax Primary email address
Education
Interests and activities
Parent’s name
Date of birth Age Occupation
Business address City State Zip
Business phone Business fax Primary email address
Education
Interests and activities
Other family/household members
Name Relation Age / Date of birth
Name Relation Age / Date of birth
Name Relation Age / Date of birth
Name Relation Age / Date of birth
Were any other family/household members born prematurely or with a birth defect or other health challenge? Please explain.
Candidate medical information
Please include a note from the child’s current physician about his present health
Child’s current physician – name
Address City State Zip
Phone Fax Other
Delivering physician - name
Address City State Zip
Phone Fax Other
At birth the child was diagnosed with (please check all that apply by marking with an X):
Premature birth
If yes, please give number of weeks at birth
Low birthweight
If yes, please give the child’s birthweight
Thyroid hormone deficiency, hearing impairment, or any other condition found through newborn screening
If yes, please specify
Persistent pulmonary hypertension (PPHN, a heart-lung malfunction)
Anemia of prematurity
Jaundice
Patent ductus arteriosus (PDA, a malfunction of blood flow from the heart)
Respiratory distress syndrome (RDS, a lung malfunction)
Necrotizing enterocolitis (NEC, a deterioration of the intestines)
Malformation of the heart, spine, or other organ or structure of the body
Other (please describe)
Treatment and/or medications used to improve the child’s health (please check all that apply by marking with an X):
Fetal surgery
Non-surgical fetal therapy (If yes, please specify)
Fetal echocardiogram (sonogram of the fetal heart)
Biophysical profile (BPP) – includes “non-stress test” of fetal heart activity, plus ultrasound assessment of amniotic fluid volume and fetal limb/body/breathing movements
NICU technology
Nitric oxide to treat PPHN
Prenatal care
Surfactant to prevent or treat RDS
Intravenous feeding (also called total parenteral nutrition, or TPN)
Medication (erythropoietin, or EPO) to treat anemia
Medication, such as indomethacin or ibuprofen, to correct PDA
Medication (prostaglandin) to preserve PDA until surgical repair of the heart malformation
Genetic counseling
Steroid treatment (before birth)
Other (please describe)
In this section, you will help us understand the story of your child’s birth. It’s important for an ambassador to be succinct and use words to maximize impact. Please use only the space given.
How did you feel when you found out you were going to have the baby?
If something was wrong, when did you know and how did you find out?
How did you feel when you learned that your baby might be born sick?
If your baby was born healthy, how did you feel?
When did you hold your baby for the first time and how did it feel?
How does it feel to be the parent of a child born sick who spent time in the NICU?
How did the March of Dimes help your child survive or be born healthy?
What impact has the March of Dimes had on your family?
What do you hope to achieve as an ambassador?
How can other people help the March of Dimes?
Volunteer history
How long have you or family members been March of Dimes volunteers?
Have you or your child ever been an ambassador? Yes No
If so, when, where and for how long?
Please list other volunteer involvement by you and your family
Please list March of Dimes events and activities in which you and your family have participated
Have you or your family ever done media interviews? Yes No
(Related to the March of Dimes or anything else)
If so, please indicate type (all that apply) Print TV Radio Online
What impact has your March of Dimes volunteer service had on you?
Application checklist
Please remember to include in your email…
q Your completed application form.
q Photos (no more than 10, in digital JPG form) that chronicle your story from the birth of your child to now. (Remember that at least one photo must be a family photo.)
q Candidate’s hospital discharge summary.
q Letter from current physician.
All materials must be returned by email by Thursday, October 13, 2011, to .
Thank you for your interest in serving as a Colorado chapter ambassador!