Youth Ambassador Application

    First Name:

    Last Name:

    Date of Birth:


    Current County of Residence

    County Where You Were in Foster Care:

    Are You Currently in Foster Care?

    Mailing address:

    Email Address:

    Phone Number:

    Additional Contact Number:

    Preferred Pronouns:

    Preferred Method of Contact:

    Preferred Times/Days to Contact You:

    Your Current Availability (Please mark the boxes with times you are available):







    Morning (8-12)

    Afternoon (12-4)

    Evening (5-8)

    The Ambassador position requires the following commitments. Any required travel will be
    covered by YEP.

    • Approximately 10 hours per month. Possible travel to Sacramento twice annually for a full day meeting

    • Travel to your regional partner’s county one time per year

    Are you able to commit to the requirements?

    What other obligations do you currently have and how much time do they require? Please check below and list the amount of time per week:




    Hours per week




    Independent Living Program

    Other obligations (please explain)

    Your Experience (please explain)

    Do you feel that you currently have a good support system?

    Where does most of your support come from?

    Which of the following areas do you have personal or professional knowledge and experience with? Please check all that apply:

    Native American/Tribal connection

    Mental Health Services



    Kinship Care

    Shelter Care

    Resource Home


    Alternative education


    Transitional Housing


    AB 12

    Short Term Residential Therapeutic Program (STRTP)

    Commercial Sexual Exploitation of Children (CSEC)

    Independent Living Program (ILP)

    Are there any other circumstances you have experienced aside from what is listed above? If so, please list them.

    Are you comfortable with sharing your personal experiences in order to help improve the child welfare system?

    Why do you want to be an Ambassador and what are you most passionate about?

    Please list the top 4 personal characteristics that will make you successful as an Ambassador. and explain in the comments section that follows why these characteristics will be important in your Ambassador work:

    Why will these characteristics be important in your Ambassador work?

    Please list any experiences and/or characteristics which make you qualified to represent other foster youth, including foster youth who may not be well represented (example: LGBTQIA, ethnic minority, young parents, etc.):

    What do you think the top 3 priorities should be for improving the child welfare system for foster youth in your county and why?

    Please list two references (personal or professional) that we can contact:


    Relationship to you:

    Phone number:


    Relationship to you:

    Phone number:

    How did you hear about the opportunity to become a youth ambassador?: