YWLA Youth Ambassador Application
The Young Worker Leadership Academy. Presented by LOHP-UC Berkeley, LOHP-UCLA and the Commission on Health & Safety and Workers' Compensation. February 6-8, 2020 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 advisor.
What is the name of your Adult Advisor? *
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.) *
Address *
Your answer
City, State, Zip Code *
Your answer
School/Organization *
Your answer
Cell Phone Number
Your answer
Home Phone Number
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Grade
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
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.
*
Required
Please submit all forms by October 31, 2019
If you have any questions or concerns please email joselyn@berkeley.edu
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