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.
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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 *
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DD
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Grade
Email *
Gender
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? *
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 5pm on December 4, 2020.  
If you have any questions or concerns please email elisha.jaeke@berkeley.edu.
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