Youth Ambassador Application Name: Date of Birth: County: Mailing address: Email Address: Phone Number: Additional contact number: Preferred Method of Contact: Cell PhoneEmail Preferred Times/Days to Contact You: Your Current Availability (Please mark the boxes with times you are available): Time Monday Tuesday Wednesday Thursday Friday Saturday Sunday Morning Yes Yes Yes Yes Yes Yes Yes Afternoon Yes Yes Yes Yes Yes Yes Yes Evening Yes Yes Yes Yes Yes Yes Yes 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? YesNo 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: Obligation Yes No Hours per week Job Yes No Family Yes No School Yes No Independent Living Program Yes No Other obligations (please explain) Do you feel that you currently have a good support system? YesNoSomewhat Where does most of your support come from? AdultsYouthBoth Which of the following areas do you have personal or professional knowledge and experience with? Please check all that apply: Native American/Tribal connection Yes Mental Health Services Yes Medications Yes Adoption Yes Kinship Care Yes Shelter Care Yes Foster Home Yes Probation Yes Alternative education Yes Homelessness Yes Transitional Housing Yes Cal-Fresh Yes AB 12 Yes Group Home Yes 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? YesNoMaybe 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: Name: Relationship to you: Phone number: Name: Relationship to you: Phone number:
