Otweya Youth Empowerment Program Application
Welcome! The Otweya Youth Empowerment Program, led by Live Out Loud Namibia & 4C For All, is a 9-month mentorship and personal growth journey for young people aged 10–25.Please answer these questions so we can get to know you and match you with a mentor.
Section 1: Personal Information
Full Name
*
First Name/Given Name
Last Name/Surname
Preferred Name
Date of Birth
*
-
Day
-
Month
Year
Date
Gender
*
Please Select
Female
Male
Non-binary
Prefer not to say
*
Email (if you have one)
example@example.com
Region of Residence
*
Town / Settlement
*
Emergency Contact Name
*
First Name
Surname
Emergency Contact Phone/WhatsApp
*
Emergency Contact Relationship to You
*
Section 2: Education and Interests
Current Status
*
Please Select
In School (Grade 1–7)
In Secondary School (Grade 8–12)
Not in School and Not Working
In Vocational Training (VTC)
Employed
If in school, what is the name of your school?
What are two goals you hope to achieve in the next 9 months?
*
(e.g., youth work, counselling, leadership, teaching)
Why do you want to join the Otweya Youth Empowerment Program?
*
Which topics interest you most?
*
Leadership & Community Service
Career & Entrepreneurship
Emotional Well-being & Mental Health
Healthy Relationships
Skills Training (financial literacy, digital skills, etc.)
Section 3: Availability & Commitment
Is there anything about your health, schedule, or family responsibilities we should know to support you?
Weekly Time Availability
*
1-2 hours
3-4 hours
5+ hours
Preferred Participation Format
*
In-person (community centre, schools)
Virtual (WhatsApp/Zoom/Google Meet)
Both
Section 4: Technology
Device Availability
*
I have my own smartphone, laptop, or tablet with internet or data/Wi-Fi.
No, I will need to use an Otweya/partner centre device on-site (cannot be taken home).
How would you rate your comfort level with using technology (smartphones, computers, internet)?
*
Very Comfortable – I use a smartphone or computer every day and can easily learn new apps.
Comfortable – I use WhatsApp, Facebook, TikTok, or email most days and can follow instructions to try new tools.
Somewhat Comfortable – I use a phone for calls and WhatsApp but need guidance for new apps or websites.
Not Very Comfortable – I rarely use social media or online tools and will need extra support.
Section 5: Consent
If under 18: Parent/Guardian Name
First Name
Surname
Parent/Guardian Consent for Participation
Continue
Continue
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