Public Engagement Ambassadors Application Form (2022) Question Title * 1. Name: Question Title * 2. Current position: Question Title * 3. Research Group Leader/Line Manger: Question Title * 4. Expected end date of contract or course: Date Date Question Title * 5. Describe your research (or the research you are involved in), in less than 200 words and in a way that could be understood by an adult visitor to a science fair: Question Title * 6. Describe any previous public engagement experience or involvement: Question Title * 7. Why do you want to become a public engagement ambassador? Question Title * 8. What audiences are you interested in engaging with? Primary school (4-11 year olds) Secondary school (11-16 year olds) A-level/college students (16-18 year olds) Adults Specific patient groups (please specify) Other (please specify) Specify group: Question Title * 9. Do you have a particular interest or skills in any of the following forms of communication? Art and design Video or animation Website or digital design Computing/app development Construction (e.g. props, gadgets, electronics) Journalism or writing Performance or theatre Please briefly describe any experience that you have in these (or similar) areas. Question Title * 10. Have you checked with your supervisor/line manager they are happy for you to commit your time to the scheme? Yes No If no, please specify Done