Heart to Heart Ambassador Application











































































Please note: Each application is assessed on individual merit and a conviction may not necessarily exclude you from volunteering with ACHA


Letters of Reference:
We are looking for Ambassadors who are thriving congenital heart patients or family members of congenital heart patients.

You are asked to provide 3 letters of reference from non-family members. One letter must be from an ACHD healthcare professional and another from someone who knows you professionally, such as an employer, teacher or volunteer coordinator. If you are applying as an ACHD family member, in lieu of a reference letter from an ACHD health care provider, please submit a second letter from someone who knows you professionally.

All letters should address the following areas: commitment, reliability, accomplishments, strengths, experience in dealing with people, how you handle challenges, and why they believe you are a good example of someone who thrives with CHD. Your ACHD healthcare professional should also address that you are compliant and understand the need for lifelong ACHD care. All professional letters should be submitted on letterhead. Letters should be emailed to lcohen@achaheart.org or faxed to 215-849-1261. Who should we expect a letter from?

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I have received and read ACHA's Heart to Heart program description and understand and accept the role of an Ambassador. Additionally, I accept the responsibility of the limits of this role, as outlined below:

  • An Ambassador is not a therapeutic counselor
  • An Ambassador does not dispense medical advice
  • An Ambassador is not expected to be a member's main source of support

By signing this form (type your full name), I acknowledge that limited confidential medical information (including name, age, diagnosis) pertaining to me may be released to an ACHA member who I will be matched with. This information will be transmitted by ACHA staff to the Heart to Heart Ambassador and will be kept in the strictest confidence.





Thank you for your interest in the Adult Congenital Heart Association's Heart to Heart Program