YWLA Youth Ambassador Application
The Young Worker Leadership Academy. Presented by UC Berkeley, UCLA and the Commission on Health & Safety and Workers' Compensation. February 1-3, 2018 in Berkeley, CA
You Must Apply with a Team
To apply, you must have a team of 4 youth (and a 5th youth alternate) AND you must also have an adult sponsor.
What is the name of your Adult Sponsor?
Your answer
Youth Name (First and Last)
Your answer
Are you applying as a Youth Alternate on the team? (This means you will only attend the YWLA if another team member cannot attend.)
Street Address
Your answer
City, State, Zip Code
Your answer
School/Organization
Your answer
Cell Phone Number
Your answer
Home Phone Number
Your answer
Age
Your answer
Email
Your answer
Gender
Your answer
How did you hear about this program?
Your answer
Briefly answer the following questions below:
Why are you interested in this project?
Your answer
What qualities best describe you?
Your answer
Tell us about your work experience (paid or unpaid) or other community projects with which you have been involved:
Your answer
What social media platforms do you use?
Agreement
Required
Please submit all forms by November 7, 2017
If you have any questions or concerns please email joselyn@berkeley.edu
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