RYLA STUDENT APPLICATION-rev

STUDENT APPLICATION
Rotary Youth Leadership Awards Conference
Sponsored by Rotary Clubs of District 6560
March 27 – 29, 2026
SPONSORING ROTARY CLUB INFORMATION
ATTENTION STUDENTS:
1. IF YOU RECEIVED THIS FORM WITH THIS SECTION COMPLETED, PLEASE DO NOT CHANGE IT.
2. IF IT IS NOT COMPLETED, USE THE INFORMATION YOU WERE PROVIDED BY YOUR ADVISOR, ON THE FLYER, OR FROM YOUR ROTARY CLUB SPONSOR TO COMPLETE THIS SECTION.
3. THE ROTARY CLUB SPONSOR LISTED BELOW WILL AUTOMATICALLY RECEIVE AN EMAIL WITH A COPY OF YOUR FORM WHEN YOU SUBMIT IT.
Name of Sponsoring Rotary Club*
Name of Sponsor (Rotary Club Member)*
Phone of Sponsor (Rotary Club Member)
Format: (000) 000-0000.
Email of Sponsor (Rotary Club Member) *
example@example.com
STUDENT APPLICANT INFORMATION
If you are uanble to complete this form in one sitting, you can click the SAVE button at the bottom and you will receive an email with a link so you can finish it at a later time.
Full Given Name*
Preferred Name or Nickname*
Email*
example@example.com
Phone*
Format: (000) 000-0000.
MobileHomeOffice
Name of High School*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Age*
Gender*
Grade*
Sweatshirt Size*
Name of Parent/Guardian*

First NameLast Name
Email of Parent/Guardian*
example@example.com
EMERGENCY CONTACT INFORMATION
Name of Emergency Contact*
Emergency Phone*
Format: (000) 000-0000.
MobileHomeOffice
Relationship*
STUDENT BIO/RESUME

Upload bio/resume or complete sections below
FriendFamily MemberAdvisorTeacherPrincipalInformation on CampusOther
Yes, I am in an Interact ClubFamily Member is a member of Rotary, Rotaract or InteractNo I do not have a connectionOther
Upload Recent School Photo*

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Upload Bio/ResumeComplete sections below
Upload student bio/resume*

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Special Interests and Talents
Extra Curricular Club or Athletic Activities
Awards (School/Civic)
Leadership Positions
Thank you for your interest in applying for RYLA!
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STUDENT APPLICATION

SPONSORING ROTARY CLUB INFORMATION

STUDENT APPLICANT INFORMATION

EMERGENCY CONTACT INFORMATION

STUDENT BIO/RESUME