Stroke Ambassador Casting Application

The American Heart Association is looking for stroke survivors from Greater Boston to share their stories and inspire others. You could become a local spokesperson, representing the American Heart Association in marketing materials, at events, online and in the media. Please submit your application before the Sept. 30, 2020 deadline.

Who are you nominating?

SelfSomeone else

How do you know the person you are nominating?

Your Name

First NameLast Name

Your Email

example@example.com

Name of person being nominated*

First NameLast Name

Email of person being nominated*

example@example.com

Phone Number of person being nominated

Area CodePhone Number

How many strokes have you/the nominee had?

How long has it been since your/their last stroke?

What is your/their date of birth?

MonthDayYear

What is your/their gender?

How did you learn of this opportunity?

Posting on Encompass Health website/social mediaPosting on American Heart Association website/social mediaMy doctorFlyer at an Encompass Health locationFriend or family memberOther

Tell us your/their story. How was life before and after stroke? Does heart disease and stroke run in the family? Share details on the recovery process. *

0/750

If selected as an Ambassador, are you comfortable having your story shared on the American Heart Association and Encompass Health social media pages?

YesNoOther

If selected as an Ambassador, are you comfortable speaking to stroke patients/groups/at events hosted by the American Heart Association?

YesNoOther

Submit a picture(s) of yourself and/or a video (55 seconds or less) detailing your stroke journey.

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