RYLA Application Form - 2017

Rotary Youth Leadership Awards Program
Loyalist College, Belleville, Ontario

Sunday May 14 to Friday May 19, 2017

(Detailed Instructions: http://rotary7070.org/Documents/en-ca/65a5f112-ac3c-49ab-865f-54d32dd8aabd/1 )

NOTE - Information collected in this form will be used by the RYLA Committee in the applicant selection process.

DUE: April 1, 2017

Applicant Name
Your answer
Phone
Your answer
Date of Birth
MM
/
DD
/
YYYY
Address
Your answer
Email
Your answer
Present Status
Work History (part time and full time)
Your answer
Volunteer Activity (agencies served and personal activity)
Your answer
Leadership Roles (school, sport, church, club, community)
Your answer
Awards Received (academic, sports, community, etc.)
Your answer
Academic Achievement - Level Completed
Your answer
Academic Achievement - Average Grade
Your answer
Sponsoring Organization
Club / Institution Name
Your answer
Rotary Sponsor Name
Your answer
List Food Allergies or Dietary Restrictions
Your answer
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