Rotary Youth Leadership Program: Counselor Application
Application Instructions:
Fill out and submit this application electronically (online).
We recommend that 'essay' questions be drafted in Word or other word processing software then 'cut & paste' into application.

IF you cannot complete the application online in one sitting:
1. Click SUBMIT to save your work so far
2. Click EDIT YOUR RESPONSE
3. Add this page to your "Favorites" to save the link. You only need to do this once to revisit your application anytime.
4. Click SUBMIT each time you add to the application or edit. This will save your information.

NOTE: If you are offered a position as a counselor, it will be contingent upon the completion of a background check. Your prompt cooperation in providing information for the background check will be expected.

Email address *
Last Name *
Your answer
First Name *
Your answer
Preferred Name *
Your answer
Date of Birth *
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DD
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YYYY
*
Home Address *
Your answer
City/State/Zip *
Your answer
Cell Phone *
Your answer
Email *
Your answer
T-shirt Size
Your answer
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