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. The 2021 YWLA will be held virtually from Thursday, March 4, through Saturday, March 6th, 2021.
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? *
Name (First and Last) *
Address *
City/State/Zip Code *
School/Organization *
Cell Phone Number
Email *
Date of Birth *
Briefly answer the following questions below:
Why are you interested in continuing your involvement with this project? *
What qualities do you have that will help you be a mentor to youth your age? *
Tell us about your work experience (paid or unpaid) or other community project(s) with which you have been involved: *
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? *
How will you manage your school/work and youth mentor responsibilities before and after the YWLA? *
Do you have access to a laptop with video and audio capacity, as well as stable internet? *
Check your preference on the Youth Mentor training options.
You are required to participate in a 6-hour training before the YWLA Academy to prepare.
The Youth Mentor training will happen virtually, would you prefer the training happen in one full day Saturday or split into two, 3-hour sessions on two Saturdays in February? *
Agreement *
Please submit all forms by 5pm on December 4, 2020.
If you have any questions or concerns please email
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