- Dravet Syndrome Foundation

2025 DSF Family Network Ambassador Application

Name(Required)

First Last

Facebook name (if different than name listed above)

Email(Required)

Age of patient with Dravet syndrome(Required)

Are you registered with the DSF Family Network?(Required)

Yes

Unsure

Address(Required)

City State / Province / Region

Are you fluent in any language other than English?(Required)

Yes

If "yes", which language(s) are you fluent in?

If given the opportunity to be a Family Network Ambassador, I am willing to dedicate 3-5 hours per month to the role(Required)

I acknowledge

It is expected that a Family Network Ambassador attends both the biennial conference in June 2026 and a Day of Dravet workshop in 2027. What barriers might prevent you from attending? (Financial, support at home, work commitments/time off, other?)(Required)

Are you active in the support groups on Facebook? If so, what groups are you active in?(Required)

Share the skills and/or experience you would bring to this volunteer position.(Required)

Describe your virtual/social media presence and how you spread awareness of Dravet syndrome and DSF.(Required)

Share what events and/or fundraisers (virtual or in person) you may have participated in to help support the DSF community.(Required)

Describe your past or current involvement (paid or unpaid) with any of the following – Volunteer organizations (such as Epilepsy Foundation, Girl Scouts of America, Special Olympics, etc.), pharmaceutical companies/industry partners (such as advisory boards, media opportunities, surveys, etc.), other organizations (such as hospitals, advocacy, schools, etc.).(Required)

Describe what the DSF Mission means to you and why you want to be a Family Network Ambassador.(Required)

Is there anything else that you think would be important for us to know about you or your family?