JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
2024 Student Application - District 6540 Rotary Youth Leadership Awards (RYLA)
RYLA Application
Enter your sponsoring Rotary Club RYLA Chair's email address on the first line below. This will ensure that they get a copy of this application. Thank you!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Student Email
*
Your answer
Sponsoring Rotary Club
*
Choose
Albion
Angola
Anthony Wayne
Auburn
Berne
Bluffton
Boswell
Butler
Chesterton-Porter
Churubusco
Columbia City
Concord
Crown Point
Decatur
Delphi
Demotte-KV
Elkhart
Elkhart Morning
Fort Wayne
Fowler
Frontier
Garrett
Gary
Goshen
Granger Sunrise
Griffith
Hammond
Highland
Huntertown
Huntington
Kendallville
Kentland
LaGrange
LaPorte
Ligonier
Logansport
Lowell
Merrillville
Michigan City
Mishawaka
Monticello
Munster
Nappanee
North Manchester
Ossian
Otterbein
Peru
Plymouth
Rensselaer
Rochester
Roseland
Schereville
South Bend
Summit City South
Syracuse-Wawasee
Valparaiso
Wabash
Warsaw
Name of local Rotary RYLA Chair
*
Your answer
RYLA Chair Contact (Email)
*
Your answer
RYLA Chair Contact (Phone Number)
*
Your answer
First Name of Applicant
*
Your answer
Last Name of Applicant
*
Your answer
Address
*
Your answer
City
*
Your answer
State (ex. IN)
*
Your answer
Zip Code
*
Your answer
Phone Number (XXX) XXX-XXXX
*
Your answer
Birth Date
*
MM
/
DD
/
YYYY
Gender
*
Male
Female
Required
What high school do you attend?
*
Your answer
Sweatshirt Size
*
S
M
L
XL
XXL
XXXL
Emergency Contact Name
*
Your answer
Emergency Contact Relationship to Applicant
*
Your answer
Emergency Contact Phone Number
*
Your answer
Why do you want to attend RYLA?
*
Your answer
Please list current or recent leadership positions you have held.
*
Your answer
How do you feel the RYLA experience will benefit you as an individual? As a leader?
*
Your answer
Please list awards (school/civic) that you have received.
*
Your answer
What extracurricular activities do you participate in?
*
Your answer
What profession would you like to pursue following high school/college?
*
Your answer
Please complete the Health Form and Release at
rylahealthformandrelease.rotary6540.org
*
Done
A copy of your responses will be emailed to the address you provided.
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms