Climate Ambassador Due Diligence Form

Section 1: Personal Information

Name *

First

Last

Date of Birth *

Date of Birth

Contact Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Gender

Email *

Phone / WhatsApp Number: *

Preferred Language of Communication

Section 2: Professional Background

Current Occupation / Role:

Organization / Institution

Field of Expertise:

Environmental Science
Renewable Energy
Education / Advocacy
Policy & Governance
Technology & Innovation
Agriculture / Forestry
Other

Years of Professional Experience:

Educational Qualification(s):

Action a /

Section 3: Climate Action Involvement

1. Describe your current or previous engagement in environmental or climate-related initiatives:

2. What motivates you to serve as a Climate Ambassador?

3. Areas of Interest / Focus as an Ambassador (select up to three):

Section 4: Commitment & Availability

How many hours per week can you dedicate to Ambassadorial activities?

2–5 Hrs
6–10 Hrs
11–15 Hrs
16+ Hrs

Are you willing to represent the initiative in regional and international events (virtual/in-person)?

Do you agree to uphold the values, ethics, and mission of the UN Climate Action Programe?

Date / Time

Date

Time

Section 5: Supporting Documents

Copy of Valid ID / Passport

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.

Recent Passport Photograph

Drag & Drop Files, Choose Files to Upload

Updated CV / Profile Summary

Drag & Drop Files, Choose Files to Upload You can upload up to 4 files.

Any Certificates or Evidence of Climate-related Work

Drag & Drop Files, Choose Files to Upload You can upload up to 8 files.

Live Verification Camera *

Camera Preview

Nomination Number *

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Due Diligence Form For Prospective Climate Ambassadors

Section 1: Personal Information

Section 2: Professional Background

Section 3: Climate Action Involvement

Section 4: Commitment & Availability

Section 5: Supporting Documents

Climate Action Network Canada (CAN Canada) is a national coalition of environmental organizations, Indigenous groups, labour unions, youth networks, faith communities, and social justice advocates working together to advance bold, science-based climate solutions across Canada.