RYLA TEEN APPLICATION - Microsoft



| |RYLA 2020 |

| |DEAR RYLA REP – |

| | |

| |PLEASE PUT YOUR NAME AND CONTACT INFO AT THE BOTTOM OF THE |

| |TEEN APPLICATION FORM **BEFORE** YOU MAKE COPIES OR SEND IT |

| |OUT ELECTRONICALLY OR TEENS WILL **NOT** KNOW HOW TO CONTACT|

| |YOU! |

| | |

| |ALSO, PLEASE FILL IN THE “DUE DATE” WHEN YOU WANT THE YOUTH |

| |TO TURN IN THEIR APPLICATIONS, AS WELL AS WHERE YOU EXPECT |

| |THEM TO TURN THE FORMS IN. OFTEN TIMES THIS BECOMES THE |

| |GUIDANCE COUNSELOR’S OFFICE IN THE HIGH SCHOOL. BUT THIS |

| |LOCATION IS YOUR CHOICE. THIS INFORMATION IS ENTERED AT THE|

| |TOP OF THE TEEN APPLICATION FORM. AGAIN, ENTER THIS |

| |INFORMATION**BEFORE** YOU MAKE COPIES OR SEND IT OUT |

| |ELECTRONICALLY OR TEENS WILL **NOT** KNOW WHERE AND WHEN TO |

| |SUBMIT THE FORM. |

| | |

| |PLEASE KEEP IN MIND THAT THE DATE YOU SET AS THE APPLICATION|

| |DEADLINE NEEDS TO CONSIDER THAT CLUB REPS WILL NEED TO |

| |INTERVIEW, MAKE THEIR SELECTION OF PARTICIPATING YOUTH, AND |

| |SUBMIT THEIR YOUTHS’ NAMES BEFORE JANUARY 31st. |

| | |

| |NOTE: |

| |DON’T FORGET TO DELETE THIS COVER PAGE WHEN YOU ADD YOUR |

| |NAME AND CONTACT INFO TO THE BOTTOM OF THE APPLICATION. IT|

| |IS HELPFUL IF YOU SAVE THE FILE AS YOUR ROTARY CLUB_NAME |

| |_TEEN APPLICAION |

|[RYLA TEEN APPLICATION] |

|SEE the bottom of the attached form – RYLA Reps need to delete this cover page and edit the form so that it has your contact information on the line just above the |

|highlighted “Rotary Club,” “RYLA Rep Name,” etc. Questions or for help if you do not know how to do this call Beth Trowbridge (907) 399-6756 or Peggy Pollen at |

|907-388-2283. Thanks! |

RYLA TEEN APPLICATION

Deadline to submit this application is JANUARY 31, 2020.

TEEN INFORMATION (PLEASE PRINT)

PLEASE ANSWER THE FOLLOWING QUESTIONS ON A SEPARATE SHEET OF PAPER.

NOTE: Answers should not exceed 50 words per question. Please type or write (print) clearly.

1. What are you passionate about?

2. What are your hobbies and interests?

3. Tell us about one or two of your goals that you have set for yourself.

4. How do you make a difference in the lives of your family, friends and community? (For example, do you help take care of younger siblings, help your parents or grandparents or volunteer at a local non-profit)?

5. What motivated you to apply to attend RYLA?

6. What type of service projects/service organizations interest you most? Please check your top two choices.

Elderly/Senior Care Service Youth Service Disadvantaged Service

Outdoor/Nature Service Other:

PARENT/GUARDIAN INFORMATION

Parent/Guardian Name_________________________________________________________

Mailing Address _____________________________________________________________

Home Phone ________________ Work Phone ________________ Cell Phone ______________

✓ I give permission for_________________ to attend RYLA 2020 in Homer, AK, Thursday, March 5 through

✓ Sunday, March 8, 2020.

✓ I understand that I am responsible for arranging necessary time away from school, including travel time.

✓ I/We have reviewed and agree to the RYLA 2020 FAQ’s.

✓ If I have questions, I will contact the local Rotary Club Representative below with any questions.

✓ I give permission for photos to be taken and published for Rotary activities for print or web. __ Yes or __ No

_________________________________ ________________________________

Parent/Guardian Signature Date Teen Signature Date

Printed name: Printed name:

Any questions? Please contact:

Rotary Club RYLA REP Name Phone EMAIL or Fax

-----------------------

Name: Gender: M / F

High School: Grade: 10 or 11

Age: Birthday (DD/MM/YYYY): / /

Mailing Address: City:

Province/ State: Postal / ZIP Code:

Home telephone: ( ) Cell Phone: ( )

Email 1: Email 2:

Sweatshirt size (circle one): S M L XL XXL Other:______ Tee shirt size (circle one): S M L XL XXL Other:_______

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