Youth Mentor Application
The Young Worker Leadership Academy: Presented by LOHP-UC Berkeley, LOSH-UCLA and the Commission on Health and Safety and Workers' Compensation. February 7-9, 2019 in Berkeley, CA.
Become a Youth Mentor
In order to become a youth mentor you must have previously attended the Young Worker Leadership Academy.
What year did you attend the YWLA? *
Your answer
Name (First and Last) *
Your answer
Address *
Your answer
City/State/Zip Code *
Your answer
School/Organization *
Your answer
Cell Phone Number
Your answer
Email *
Your answer
Gender
Your answer
Date of Birth *
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DD
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Grade
Your answer
Briefly answer the following questions below:
Why are you interested in continuing your involvement with this project? *
Your answer
What qualities do you have that will help you be a mentor to youth your age? *
Your answer
Tell us about your work experience (paid or unpaid) or other community project(s) with which you have been involved: *
Your answer
From the experience that you gained from working on your project, what would you like to share with other youth who will be doing their own projects? *
Your answer
How will you manage your school/work and youth mentor responsibilities before and after the YWLA? *
Your answer
What social media platforms do you use?
Check ALL of the times below that you are available.
You are required to participate in an all-day training before the YWLA Academy to prepare. Once the youth mentors have been selected, we will set the training date.
*
Required
Agreement *
Required
Please submit all forms by November 7, 2018
If you have any questions or concerns please email joselyn@berkeley.edu
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