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 *
Gender
Date of Birth *
MM
/
DD
/
YYYY
Grade
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? *
Required
Agreement *
Required
Please submit all forms by 5pm on December 4, 2020.
If you have any questions or concerns please email elisha.jaeke@berkeley.edu.
Submit
Never submit passwords through Google Forms.
This form was created inside of UC Berkeley. Report Abuse