RYLA Application

2018 Great Plains RYLA, July 18-22

We are excited that you’ve visited the application page. Please check back very soon to fill out your application to RYLA by March 24th 2018, 11:59 PM. When you submit an application, it will be reviewed by the District 5630 RYLA Committee and you will be scholarships to the 2018 RYLA will be awarded soon.

We will be looking forward to welcoming you to Halsey, NE and the Great Plains Rotary Youth Leadership Awards Camp on July 18, 2018.

If you are human, leave this field blank.

Personal Data

First Name *

Middle Initial

Last Name *

Mailing Address *

City *

State *

Zip Code *

Primary Phone Number *

Email Address

Gender *

Current Grade *

School *

Club *

Special Information Needed

The information in this section will only be used if you are accepted to the Great Plains RYLA program. It will also not appear on the application that will be reviewed.

First Name for Name Tag *

Please indicate how you want your name to appear on your name tag. No nicknames. (If you name is Jonathan, but you go by Jon, then indicate Jon. If you first name is Jerry, but you go by your middle name Andrew, then indicate Andrew.

Adult T-Shirt Size *

Do You Have any Food Allergies? *

Do not include allergies to medication or environmental factors

Indicate Any Food Allergies Here *

You will indicate allergies to medication, things in nature, etc. on the medical form you will submit later

Parent/Guardian Information

This information will only be used if you are accepted to the Great Plains RYLA program.

Parent/Guardian First *

Parent/Guardian Last *

Parent/Guardian E-mail

Parent/Guardian Phone *

Parent/Guardian Relationship to Student *

Emergency Contact Information (Someone other than a parent not living in the same home)

This information will only be used if you are accepted to the Great Plains RYLA program.

Emergency Contact First Name *

Emergency Contact Last Name *

Emergency Contact Phone Number *

Student Relationship to Emergency Contact *

Vision

Please explain what you hope to gain by participating in RYLA. *

Rotary’s motto is “service above self.” What does that mean to you? *

Past and Current Experience

Have you ever volunteered before?

If you select "Yes," you will enter additional information.

List any past or present volunteer experiences including dates volunteered and position responsibilities

Do you currently have a job?

If you select "Yes," you will enter additional information.

List up to three past or current paid job experience including dates employed and responsibilities. Start with your most recent

Include Employer: Dates: Job Duties:

Have you received any awards or honors?

If you select "Yes," you will enter additional information.

List awards or recognitions that you received for academic, school, or community activities beginning in the 7th grade

Be sure to include: Organization/Activity: Grade(s): Leadership Responsibility/Involvement:

Have you participated in extracurricular activities or organizations?

If you select "Yes," you will enter additional information.

Please list, in order of importance to you, any school, religious, social, athletic, hobbies or other activities or organizations which you have participated in since the 7th grade

Applicant Commitment

You will be asked to download, print out, and sign a Commitment Form after submitting this application. This is to be sent to your RYLA Representative for your local Rotary Club. It must be sent within one week of completing the application. If this form is not received, your application will be considered incomplete and will not be considered.
IF YOU ARE SELECTED AND THEN ARE UNABLE TO ATTEND RYLA, YOU WILL BE RESPONSIBLE FOR 1/2 OF THE CAMP FEE (OR $200) TO YOUR SPONSORING CLUB.OF CAMP.