District 6540 Rotary Youth Leadership Awards (RYLA) Student Application-2023

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RYLA Application

Email *

Sponsoring Rotary Club *

Name of local Rotary RYLA Chair *

RYLA Chair Contact (Email) *

RYLA Chair Contact (Phone Number) *

First Name of Applicant *

Last Name of Applicant *

Address *

City *

State (ex. IN) *

Zip Code *

Phone Number (XXX) XXX-XXXX *

Birth Date *

YYYY

Gender *

Male

Female

Required

What high school do you attend? *

Sweatshirt Size *

XXL

XXXL

Emergency Contact Name *

Emergency Contact Relationship to Applicant *

Emergency Contact Phone Number *

Why do you want to attend RYLA? *

Please list current or recent leadership positions you have held. *

How do you feel the RYLA experience will benefit you as an individual? As a leader? *

Please list awards (school/civic) that you have received. *

What extracurricular activities do you participate in? *

What profession would you like to pursue following high school/college? *

Please complete the Health Form and Release at rylahealthformandrelease.rotary6540.org *

A copy of your responses will be emailed to the address you provided.

Submit

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