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RYLA 2024 Official Student Application

March 1 @ 8:00 am - April 18 @ 5:00 pm

« RYLA 2024 Student Selection Form

RYLA 2024 Official Student Online Application Form

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Welcome to the RYLA Conference.
Thank you for your interest and nomination for the Rotary Youth Leadership Awards (RYLA) Conference.

Rotary International District 7505 is pleased to provide young people with an incredible opportunity in leadership training. This is a very competitive program, with many students vying for admission, you further understand that you MUST attend the RYLA Conference in its entirety to be eligible. You must be available to attend the entire session.

Sunday, June 23, 2024 through Thursday, June 27, 2024.

In the event that you cannot attend due to unforeseen circumstances, you must make your Rotary Club sponsor aware with a minimum of two (2) weeks notice, so that they can notify the student alternate to take your place. Failure to give ample notice as noted above will require a reimbursement to the Rotary Club fee of $450.00.

Exceptions to the two (2) week notice will require verification in the form of a doctor's note due to illness, or review of the current situation by the RYLA Chairperson, Claudia Kammer, at [email protected].
Student Contact Information
Student - High School Name*
What is the name of your High School?
Student's Name*
First Last
Student's Email - DO NOT USE YOUR SCHOOL EMAIL.*
Enter Email Confirm Email
Student's Mailing Address*
Street Address Address Line 2 City State ZIP Code
Student's Cell Phone Number*
In case of emergency or additional information, we must be able to communicate with you before or at the conference.
Student's Age - Must be a junior in High School*
What is your current age?
Student - Your gender at birth*
- Male
- Female
Student - What is your Pronoun?*

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Sponsoring Rotary Club and Youth Program
Student - Are you an ALTERNATE?*
An Alternate is someone who is on the "WAIT LIST". A selected student is someone who has received a letter or phone call from the sponsoring Rotary Club that you have seen selected to attend RYLA.
- Yes, I am on the wait list
- No, I was selected to attend RYLA by the Rotary Club
Student - Are you a member of a Rotary Interact Club?*
Interact Clubs are Rotary Sponsored Service Clubs at your school, or are community based. This is not a requirement to attend!
- Yes
- No

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Rotary Club Sponsor
What is the name of the Rotary Club that sponsored you? If you were selected by your Guidance Department, please ask your guidance counselor to provide the name of the Rotary Club that will be sponsoring you.
Rotary Club Sponsor - Please use caution. Selecting the correct name is important.*
Please select the name of the Rotary Club who is sponsoring you to attend RYLA, even if you are on the wait list as an alternate.

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Student - Conference Information
Please provide the following information so that we can make this experience for you as memorable and exciting as possible.
What is your future career path?
Business professionals will be available to speak to you on some of the listed careers.
T-Shirt Size*
All T-shirt sizes are ADULT sizes only.
- Small
- Medium
- Large
- XL
- XXL
- XXL
- XXXL

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Parent/Guardian Information
Answers to all questions below are based two (2) Custodial Parent(s) or Guardian(s). Use the response "N/A" for the second if there is only one entry.
Parent/Guardian #1 First and Last Name*
First Last
Parent/Guardian #1 Email*
Email addresses are gathered only for Rotary RYLA purposes for the event in June 2024.
Enter Email Confirm Email
Parent/Guardian #1 Cell Phone Number*
Cell phone numbers are gathered only for emergency purposes at the Rotary RYLA event held in June 2024.

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Parent/Guardian #2
Use the "N/A" response if the following entries are not applicable.
Parent/Guardian #2 First and Last Name
"N/A" if not applicable.
First Last
Parent/Guardian #2 Email
Email addresses are gathered only for Rotary RYLA purposes for the event in June 2024.
Enter Email Confirm Email
Parent/Guardian #2 Cell Phone Number
Cell phone numbers are gathered only for emergency purposes at the Rotary RYLA event held in June 2024.

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Mandatory Parent/Guardian/Student Meeting (Parent/Guardian can also be: Parent/Guardian/Sibling over 18 yrs./Rotarian from Sponsoring Club/Teacher/Guidance Counselor)
The RYLA Committee will be holding four (4) Mandatory meetings for Parents/Guardians and Students in late April and Early May.

The purpose of the meetings are to submit necessary paperwork for your attendance at the conference.

At these Mandatory Meetings, we will be looking for your Medical Release Form with proper signatures from your doctor and Parent/Guardian, the Waiver and Release Form, and the Student Code of Conduct.
Which County do you live in?*
- Atlantic
- Burlington
- Camden
- Cape May
- Cumberland
- Gloucester
- Ocean
- Monmouth
- Salem
Mandatory Meeting Locations*
Mandatory Meetings are for Parent/Guardian, the student (including alternates). Required paperwork (Medical form signed by doctor and parent/guardian; Code of Conduct; Waiver and Release) will be collected at that time.

MORE DETAILS: You will receive more details about where at the location in a "CONFIRMATION EMAIL".
- Monday, April 29, 2024 - 6:30PM, Woodstown High School, 140 East Avenue, Woodstown, NJ 08098
- Tuesday, April 30, 2024 - 5:00PM, Southern Regional Senior High School, 90 Cedar Bridge Road, Stafford Township, NJ 08050Third Choice
- Tuesday, May 7, 2024, 6:30PM, Rowan College of South Jersey - Cumberland Campus, 3322 College Drive, Vineland, NJ 08360
- Friday, May 10, 2024, 6:30PM, Overbrook High School, 1200 Turnersville Road, Pine Hill, NJ 08021

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Closing Ceremony - Parent Attendance
Will your Parent(s)/Guradian(s) be attending the Closing Ceremony on Thursday, June 27th from 5:30PM to 7:00PM?*
The cost is $25.00 per person and includes dinner with your student prior to the ceremony. The payment can be received at the Mandatory Meeting or the Registration date on Sunday, June 23 between 1:00PM and 3:00PM. Made Payable to: Rotary District 7505 RYLA
- Yes, my parent/guardian will attend.
- No, my parent/guardian cannot attend.
- I do not know at this time.
How many tickets will you need for Parent/Guardian Attendance at the closing dinner?*
Please check with your Parent/Guardian before selecting.
Student - Certification
Certification that your Parents/Guardians will be informed.*
- I, (RYLA Applicant) understand that it is my responsibility to communicate with my Parent/Guardian, the details of the RYLA Conference 2024, so that they will be aware of deadlines and so they can attend the Closing Ceremony and Dinner.
Certification and Understanding
This certification is verification that you have read all of the information provided, and that the information you have entered is true and accurate. Any falsification of information may result in disqualification from acceptance into the RYLA Conference in June 2024.

As stated above, this is a very competitive program, with many students vying for admission, you further understand that you MUST attend the RYLA Conference in its entirety to be eligible.

Sunday, June 23, 2024 through Thursday, June 27, 2023.

In the event that you cannot attend due to unforeseen circumstances, you must make your Rotary Club sponsor aware with a minimum of two (2) weeks notice, so that they can notify the student alternate to take your place. Failure to give ample notice as noted above will require a reimbursement to the Rotary Club fee of $450.00.

Exceptions to the two (2) week notice will require verification in the form of a doctor's note due to illness, or review of the current situation by the RYLA Chairperson, Claudia Kammer, at [email protected].
Student - I certify that I have read and understand the information above and have shared this information with my parent(s)/guardian(s). My typed signature below validates my understanding.*
Once submitted, your Parent(s)/Guardian(s) will also be emailed your application.
First Last
Student - Date Signed*
MM slash DD slash YYYY
Name
This field is for validation purposes and should be left unchanged.

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Details

Start:: March 1 @ 8:00 am
End:: April 18 @ 5:00 pm

Organizer

: Claudia Kammer, RYLA Chair
Phone: (609) 827-8771
Email: crkammer@aol.com

« RYLA 2024 Student Selection Form

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