Rotary Youth Leadership Awards
Iowa RYLA (Districts 5970 and 6000)
2020 RYLA Rotarian Application
Rotary Club *
Select your Rotary Club
First Name *
Last Name *
Nick Name
Name for your badge if different from your First Name
Home Address *
Enter your street address
City *
State *
Zip code *
Home Phone *
Enter your home phone number with area code in format 123-456-7890
Cell Phone
Enter your cell phone number with area code in format 123-456-7890
Email Address *
Enter a valid email address
Gender *
Birth Date *
Polo Shirt Size *
Polo shirts will be a ladies cut for females and men's cut for males unless you indicate otherwise by selecting "Other" and explaining in the text field. Also, note that polo sizes run slightly large.
T-Shirt Size *
T-shirts will be unisex so please indicate desired t-shirt size here.
Primary Contact
In case of emergency
Primary Contact's Name *
Relationship *
Primary Contact's Cell Phone Number *
Or best number to be reached anytime of day. Enter in format 123-456-7890
Other Contact
In case primary contact cannot be reached in an emergency.
Other Contact's Name
Other Contact's Cell Phone Number
Or best number to be reached. Enter in format 123-456-7890
Rotary Experience *
Briefly summarize your Rotary service. If you have previously served as a Rotarian Volunteer at RYLA, please indicate year(s) and the name of your Counselor(s).
Other Volunteer/Service Activities *
In the past five years. If none, write "none".
Youth Service *
Identify experiences you've had working with youth, if any, not already described in previous questions. If none, write "none."
Bio *
Please provide your biographical sketch as you would like it to appear in the manual; 200 words MAX! Also, please provide a photo for the manual. Send photo suitable for manual to
Medical Conditions / Physical Limitations *
Please note any medical conditions or physical limitations we should be aware. Also, identify any dietary restrictions and choices so we can coordinate with Grinnell's food serve employees. If none of these apply, write "none".
RYLA: I understand that I must be present for the entire RYLA Conference and must be at Grinnell College from 10:00 AM, Saturday, July 18, 2020 to 3:00 PM, Friday, July 24, 2020. I also understand that I must be present, at Grinnell College, for the Team Leader/Rotarian training session from 9:30 AM to 5:00 PM, on Saturday, June 20, 2020.

I waive any claims for negligence against Rotary Districts 5970 and 6000, the Rotary Clubs in those Districts and individual volunteers serving RYLA, and hereby assume the risk for any illness or injury during RYLA events.

As a Rotarian volunteer at RYLA, I understand that I must authorize a background check and I will be notified when to complete the online authorization form. I further understand that I must comply with the Iowa RYLA Youth Protection Policy and complete the Youth Protection Training, which will include a session during Team Leader/Rotarian training and may also require completion of a brief online training course.
Signature *
By typing your name in this field you agree to abide by the requirements, above.
Application Process
1. Rotarian Volunteer completes application and clicks "Submit" by April 30.
2. Application is received by the RYLA Conference Chair team.
3. Conference Chair team interviews and/or selects Rotarian Volunteers from applicants.
5. Conference Chair notifies applicants by May 15 whether or not they are selected.
6. Selected applicants complete an online background check authorization form and complete online training as may be required.

See for further information.
Thank you for applying!
Please submit your application by April 30, 2020.
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