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Regional Leadership Council (RLC) Application 2021/2022
This application is for all students interested in one of the various Regional Leadership Councils for the 2021-2022 school year. If you have any questions about the application process or the roles and responsibilities, please contact your Regional Associate:
VIRGINIA, HAMPTON ROADS, WESTERN U.S. - Pete Hansen:
pete.hansen@operationsmile.org
NORTHERN U.S. - Morgan Banaszek:
morgan.banaszek@operationsmile.org
SOUTHERN U.S. - Jackie Nguyen:
jacqueline.nguyen@operationsmile.org
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Email
*
Your email
Select Application Region
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Hampton Roads
Virginia
New Jersey
New York
Northern U.S. (all states other than NJ and NY)
Western U.S.
Southern U.S.
First Name
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Your answer
Last Name
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Your answer
Date of Birth (MM/DD/YYYY)
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Your answer
Email Address
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Your answer
Cell Phone Number
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Your answer
City
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Your answer
State
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Choose
AL
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AR
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CO
CT
DE
FL
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School Name
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Your answer
Graduation Year
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Your answer
Role in your school's Operation Smile Club. (Do you anticipate being an officer in your club next year?)
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Your answer
Are you re-applying for an another year as a RLC member?
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Yes
No
Are you interested in the Recording Secretary role? Please read the Roles and Responsibilities document for what skills this role requires.
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Yes
No
T-Shirt Size
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