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Ambassador Information Form
Please complete this form providing us with your most up-to-date information. Required fields are marked with an asterisk (
*
).
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PERSONAL INFORMATION
*
First Name
Preferred First Name
*
Last Name
*
Gender
Female
Male
Transgender
Genderqueer/Gender non-conforming
Prefer not to specify
Prefer to self disclose
If you would like to elaborate, please do so here:
*
Preferred Pronoun(s)
*
Preferred Pronoun(s)
He/him/his/himself
She/her/hers/herself
Zie/zim/zir/zis/zieself
They/them/theirs/themself
Prefer a different set of pronouns
Please specify your preferred pronoun(s) here:
*
T-Shirt Size (unisex)
*
T-Shirt Size (unisex)
X-Small
Small
Medium
Large
X-Large
XX-Large
*
Birthdate
*
Birthdate
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
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31
2025
2024
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2022
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2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
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1936
1935
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1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
*
Email Address
*
Phone Number
(format: xxx-xxx-xxx)
*
Best way to contact you?
*
Best way to contact you?
Call
Text
Email
*
Hometown (City, State)
*
High School
Search by name, city, or CEEB code, and your school name will auto-populate. If your school is not listed, you may type it in the box. Enter 000000 if homeschooled.
First Generation College-Bound
First Generation College-Bound
Yes - Neither of my parents/guardians have graduated with a Bachelor's degree from a 4-year institution
No - At least one of my parents/guardians have graduated with a Bachelor's degree from a 4-year institution
*
Graduating Year
2017
2018
2019
2020
2021
*
House Affiliation (Full Membership)
*
House Affiliation (Full Membership)
Avery
Blacker
Dabney
Fleming
Lloyd
Page
Ricketts
Ruddock
House Affiliation (Social Memberships, if any)
House Affiliation (Social Memberships, if any)
Avery
Blacker
Dabney
Fleming
Lloyd
Page
Ricketts
Ruddock
*
Option(s)
*
Option(s)
Applied and Computational Mathematics
Applied Physics and Materials Science
Astronomy
Bioengineering
Biology
Business, Economics & Management
Chemical Engineering
Chemistry
Computer Science
Economics
Electrical Engineering
Engineering & Applied Science
English
Geobiology
Geochemistry
Geology
Geophysics
History
History and Philosophy of Science
Interdisciplinary Studies Program
Mathematics
Mechanical Engineering
Philosophy
Physics
Planetary Science
Political Science
Minor(s)
Minor(s)
Aerospace
Computer Science
Control and Dynamical Systems
English
Environmental Science and Engineering
Geological and Planetary Systems
History
History and Philosophy of Science
Philosophy
Structural Mechanics
Clubs/Organizations You're Involved In (Unlimited Selection)
300 Heroes club
Aarya
Biology Undergraduate Student Advisory Committee
Bridges at Caltech
CHMMC Management Club
Caltech Alpine Club
Caltech American Institute of Chemical Engineers (AICHE)
Caltech Anime Society
Caltech Armenian Student Association
Caltech Badminton Club
Caltech Ballet Club
Caltech Ballroom Dance Club
Caltech Biotechnology Club
Caltech C (Chinese Association)
Caltech Chemistry Club
Caltech Chess Club
Caltech Chinese Student Association (CCSA)
Caltech Christian Fellowship (CCF)
Caltech Club for Computer Science
Caltech Co-Ed Volleyball Club
Caltech Consulting Club
Caltech Cricket Club
Caltech Dance Show Club
Caltech Dance Team
Caltech Dance Troupe
Caltech Dhamaka
Caltech Entrepreneurship Club
Caltech Golf Club
Caltech InnoWorks
Caltech Karate Club
Caltech Korean Student Association
Caltech Latino Association of Students in Engineering and Sciences
Caltech League of Legends Club
Caltech Math Club
Caltech Newman Center
Caltech OSA Student Chapter
Caltech Pokémon Club
Caltech Premedical Association (CPMA)
Caltech Robotics Team
Caltech Russian Club
Caltech Sailing
Caltech Salsa Club
Caltech Smash Club
Caltech Surf and Windsurf Club
Caltech Sustainable Vehicles Club
Caltech Tai Chi Club
Caltech Tango Club
Caltech Toastmasters
Caltech Ultimate Frisbee Club
Christians on Campus at Caltech
Club Latino
Dance Dance Revolution Club
EXPLiCIT
Encounter Jesus Fellowship
Engineers Without Borders Caltech Chapter
Engineers for a Sustainable World
Fluid Dynamics
Graduate Christian Fellowship
Hacktech
Hillel
IEEE
InterAxon
Jewish Life at Caltech
Keytones
MEDLIFE
Meat Club
Nerf Club
OASIS
Out of Context
PRISM
Paddling Club
Photography Club
Physics Club
Puzzle Club
Quiz Bowl
Robogals
Sargam
Science & Engineering Policy At Caltech (SEPAC)
Science Olympiad Club
Society of Women Engineers
Student Investment Fund
Tech Naach
Techer Taekwondo
Techers for a Sustainable Future (TSF)
Tennis Club
The Feminist Club
The Pipettes
UAV Engineering
Women's Soccer Club
iGem Club
oSTEM @ Caltech
If your club or organization was not listed above, please specify your other involvements here:
*
Do you participate in a sport (varsity, club, and/or intramural)?
*
Do you participate in a sport (varsity, club, and/or intramural)?
Yes
No
*
If yes, please specify which sports below.
*
If yes, please specify which sports below.
Baseball (Men's)
Basketball (Men's)
Basketball (Women's)
Cross Country (Men's)
Cross Country (Women's)
Fencing (Men's)
Fencing (Women's)
Soccer (Men's)
Soccer (Women's)
Swimming & Diving (Men's)
Swimming & Diving (Women's)
Tennis (Men's)
Tennis (Women's)
Track & Field (Men's)
Track & Field (Women's)
Volleyball (Women's)
Water Polo (Men's)
Water Polo (Women's)
OTHER (club/intramural)
*
If you have participated in a club or intramural sport, please specify below.
*
Have you studied abroad or had an international experience?
*
Have you studied abroad or had an international experience?
Yes
No
*
If yes, which program(s)?
*
If yes, which program(s)?
Cambridge Scholars Program
Copenhagen Scholars Program
École Polytechnique Scholars Program
Edinburgh Scholars Program
London Scholars Program
Melbourne Scholars Program
Other (please specify below)
*
If you have an international experience not listed above, please describe below:
*
Have you participated in the SURF program?
*
Have you participated in the SURF program?
Yes
No
*
If no, have you completed research outside of the SURF program?
*
If no, have you completed research outside of the SURF program?
Yes
No
*
Please briefly describe your research experience.
*
Please specify when you completed the SURF and briefly describe your research experience.
*
Have you had an internship?
*
Have you had an internship?
Yes
No
*
Please briefly describe your internship experience.
*
Dietary preferences/restrictions
*
Dietary preferences/restrictions
None
Vegetarian
Vegan
Kosher
Gluten-Free
Other
"Other" dietary preference. Please describe in the box.
*
If you have any FOOD ALLERGIES of which we should be aware, please describe those in box below:
YOUR FAVORITES!
Favorite Candy
Favorite Food
Favorite Movie
Favorite Professor(s)
Favorite Class(es)
ADMISSIONS AMBASSADOR HANDBOOK CONFIRMATION
Click here
to download the Caltech Admissions Ambassador Handbook.
*
*
By checking this box, I affirm that I have read, understood, and will abide by the rules and conditions set forth as stated in the updated Admissions Ambassador Handbook.
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