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. The 2021 YWLA will be held virtually from Thursday, March 4, through Saturday, March 6th, 2021.
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? *
Youth Name (First and Last) *
Are you applying as a Youth Alternate on the team? (This means you will only attend the YWLA if another team member cannot attend.) *
What language do you feel most comfortable speaking, reading and writing in? *
Address *
City, State, Zip Code *
School/Organization *
Cell Phone Number
Home Phone Number
Date of Birth *
Email *
How did you hear about this program? *
Briefly answer the following questions below:
Why are you interested in the Young Worker Leadership Academy? *
What qualities best describe you? *
Tell us about your work experience (paid or unpaid) or other community projects with which you have been involved: *
Do you have access to a laptop with video and audio capacity, as well as stable internet? *
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.
Please submit all forms by 5pm on December 4, 2020.
If you have any questions or concerns please email elisha.jaeke@berkeley.edu.
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