2019 RYLA District 7410 Application Conference Dates: June 23rd to 27th, 2019
Rotary Youth Leadership Award Conference is held each year at Keystone College in Northeastern PA. It is a 5 day, 4 night leadership program for high school sophomores who have shown leadership potential in their home, school, and community. The conference is designed to introduce participants to thoughts and ideas which will strengthen and develop their leadership skills. It also provides an environment where participants may discuss and exchange their ideas with other students from NEPA.

Leadership Program
1. Personal Assessment 8. Negotiating
2. Personal Goal Setting 9. Setting Priorities
3. Time Management 10. Delegating
4. Communication and Listening 11. Interpersonal Relationships
5. Speaking in Public 12. Team Building
6. Leadership Skills 13. Brain Storming
7. Problem Solving/ Decision Making 14. The Responsibility of Leadership

Additional RYLA Program

TEAM PROJECTS: Each student will be a member of a team during the conference. Each team works on a project that is
a hands-on experience with student planning, implementation and evaluation.

SMALL GROUP ACTIVITIES: Discussion groups are held to share and explore ideas which result from each day's programs.

SOCIAL LIFE: There is time in the program for organized sports, dancing to develop lasting friendships with other participants and staff.

The applicant must:

1. Be a sophomore ready to enter his or her junior year in the fall.
2. Have shown leadership potential in home, school, and community.
3. Demonstrate qualities of a good student.
4. Submit a completed application.
5. Be selected and sponsored by their local Rotary Club (RYLA is 100% FREE to conferee's)
6. Be accepted by the District RYLA Committee

Once you have completed this form, it will be submitted to your local Rotary Club for review. Clubs decide
on who will be accepted. If you are chosen, you will be emailed a medical form that must be signed by a doctor or school nurse and returned to the RYLA registrar. You will also then receive additional information regarding the conference.
PLEASE FILL OUT AND SUBMIT THIS FORM NO LATER THAN APRIL 1ST 2018. By doing so you agree if selected to
make this RYLA Conference June 17th to the 21st a priority! Only 80 applicants are accepted each year. It is at no financial cost to you, but the Rotary Club sponsoring you is responsible for the cost even if you cancel at the last minute.

Email address *
First Name *
Your answer
Last Name *
Your answer
Student Street Address *
Your answer
City *
Your answer
Student Phone number; Cell if available as you will be called by a Junior Counselor *
Your answer
Gender *
Shirt Size *
High School *
Your answer
Birthdate *
Your answer
Primary Parent/Guardian Name *
Your answer
Primary Parent/Guardian Contact Phone Number *
Please provide the best number to reach you including off hours and weekends
Your answer
Primary Parent/Guardian email *
This will be used for all confirmations and planning details if students email is NOT provided
Your answer
Secondary Parent/Guardian Name
Your answer
Secondary Parent/ Guardian Contact Phone Number
Your answer
Secondary Parent/Guardian email
Your answer
Sponsoring Rotary Club *
You must be sponsored by a Rotary club to attend RYLA..
By submitting this application to attend RYLA 2018 WE understand the following, acceptance to be a participant in the Rotary Youth Leadership Conference of District 7410 I will attend the entire event dated June 17th to June 21st. I also understand that participation may be terminated for in appropriate behavior, a violation of conference rules, or possession of any property that is not permitted. *
Type your full name as e-Signature, both parent and student please!
Your answer
Please share any information about significant past medical, emotional, or surgical conditions. Also, please specify if you take any medications, have allergies, or have any dietary restrictions. Keystone College has a professional dining service company that can accommodate most dietary needs for students who have special requirements. Any applicant with medical or dietary needs will receive a phone call from the registrar. *
Your answer
Following confirmation of attendance, I will respond promptly to email communication from the RYLA coordinator including submission on any additional required forms. *
Type your full name as e-Signature
Your answer
RYLA 7410 takes photographs and/or video recordings of attendees in action during the day to day activities and special events. These Photographs/Videos maybe used on the website, on social media, in newsletters, and other publications. I, being parent/guardian of applicant, authorize Rotary District 7410 to use this minors likeness, including pictures and name, for future promotion and informational materials about RYLA and Rotary Youth Programs. *
Parents/Guardian full name as e-Signature
Your answer
I, being parent/guardian of applicant, hereby consent that my child/ward may use computers which have Internet access during the RYLA Conference.
Parents/Guardian full name as e-signature
Your answer
Participant Team Interest Indicator *
Each RYLA participant is a member of a Team. Each Team plans and carries out a project during the week. Indicate the type of activity you would enjoy most by numbering the activities below in order of your preference. Number your top 4 choices. Column 1 is your first preference, Column 2 is your second, etc.
Column 1
Column 2
Column 3
Column 4
What would you say is your favorite quality or characteristic about yourself?
Your answer
What do you think is the most important thing a leader does?
Your answer
Please list any actives you are involved with and any leadership roles you hold.
Your answer
Please write a brief biography of yourself. Tell us a little about you: Hobbies, activities, favorite teams, quotes... whatever you want to share with the Rotarians. Please limit the bio to 100 words maximum.
Your answer
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