District 6540 Rotary Youth Leadership Awards (RYLA) Student Application-2022
RYLA Application
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Email *
Sponsoring Rotary Club *
Name of local Rotary RYLA Chair *
RYLA Chair Contact (Email) *
RYLA Chair Contact (Phone Number) *
First Name of Applicant *
Last Name of Applicant *
Address *
City *
State (ex. IN) *
Zip Code *
Phone Number (XXX) XXX-XXXX *
Birth Date *
MM
/
DD
/
YYYY
Gender *
Required
What high school do you attend? *
Sweatshirt Size *
Emergency Contact Name *
Emergency Contact Relationship to Applicant *
Emergency Contact Phone Number *
Why do you want to attend RYLA? *
Please list current or recent leadership positions you have held. *
How do you feel the RYLA experience will benefit you as an individual? As a leader? *
Please list awards (school/civic) that you have received. *
What extracurricular activities do you participate in? *
What profession would you like to pursue following high school/college? *
Please complete the Health Form and Release at https://form.jotform.com/193525239066159 *
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