YLI 2015 APPLICATION INSTRUCTIONS - Microsoft...2015 APPLICATION INSTRUCTIONS 1. This application should be received on or before May 1, 2015. Please mail completed applications to:

Presented by The Overland Park Rotary Club FoundationIn association with Johnson County Community College

YLI 2015 APPLICATION INSTRUCTIONS

1. This application should be received on or before May 1, 2015. Please mail completed applications to:

YLI – 2015 Applications Attn: Susan Keim, YLI Program Coordinator 625 Indiana, Lawrence, KS 66044

2. Complete Application: Your Application will only be “complete” if accompanied by the following:

- Application (Page 2), - Applicant & Parental/Guardian Commitment (Page 3), - School Staff Report (Page 4/5): Must be completed and signed by a faculty advisor or counselor, - Your Resume: Please attach a resume (1 – 2 pages) listing your goals, activities, leadership positions held, skills and achievements. Also include wallet size photo. Photo will not be returned.

3. Processing of Applications: “Complete Applications,” as defined above, which are timely received onor before May 1, 2015 will be processed by June 1, 2015. Letters of Acceptance will be issued at thattime, together with a request for full payment of the Tuition Fees of $195. Tuition Fees cover the Applicant’sprogram expenses of supplies, meals and transportation for the week. Tuition fees are fully refundable forcancellations received no later than June 30, 2015. DO NOT SEND MONEY WITH THIS APPLICATION!

4. Tuition Assistance: If you cannot afford the full tuition cost of $195, you may apply for financial aid in theform of a grant from the Overland Park Rotary Club Foundation. Have your parent/guardian submit awritten request for assistance to our Program Coordinator, Susan Keim, at the address given below. Therequest must include an explanation of the need for financial assistance.

PLEASE NOTE:If you have any questions or require assistance in completing these forms, please contact one of the

individuals listed below beginning with Susan Keim.

2015 Program Coordinator Susan Keim (816) 863-1144 [email protected]

2015 Program ChairmanDonna Lauffer(913) [email protected]


YLI 2015 APPLICATION

Your completed application must be received on or before May 1, 2015.

Parent Signature Date Parent Signature Date

This program involves physical activities. Do you have any limitations of which we need to be aware?

Yes ___ No ___ If so, please identify and explain. _________________________________________________________

______________________________________________________________________________________________

Do you have any dietary restrictions? Yes ___ No ___ If so, please explain. _______________________________________

______________________________________________________________________________________________

How did you find out about YLI? _____________________________________________________________________

______________________________________________________________________________________________

Student’s Name: Address:Telephone(s): City/State/Zip:Email: High School:Date of Birth: Current Grade:

Parents/Legal Guardians

Father’s name: Mother’s Name:Address: Address:Home Phone: Home Phone: Occupation: Occupation:Work Phone: Work Phone: Email: Email: Emergency #: Emergency #: Rotarian? YES or NO Rotarian? YES or NO


YLI APPLICANT & PARENTAL/GUARDIAN COMMITMENT FORM

The success of our Youth Leadership Institute (YLI) program depends upon the interaction and teamwork of allYLI participants. Consequently, acceptance of your Application is contingent upon your commitment to attendthe Get Acquainted Bar-B-Q and all five (5) program sessions. Please review this schedule and plan your timecommitment accordingly:

YLI 2015 SCHEDULE

Kick-Off: An evening BBQ The Week of the Program:

· Reach new heights at Wildwood Adventure Course· Hear from government officials and business leaders.

· Visit Fort Leavenworth.· Connect with community leaders.

· Interview Rotarians and then, celebrate with new friends at the graduation ceremony. A Few Weeks Later

Impact your community. Donate your time to a local non-profit

As a pre-condition to consideration and acceptance of the enclosed Application, the undersigned Student and the Student’s Parent/Guardian agree and commit that the Student will attend the Get Acquainted Bar-B-Q and all five (5) program sessions.

The Student and Parent/Guardian acknowledge that if the Student does not faithfully attend the Bar-B-Q andall program sessions, the opportunity for a successful program for the Student and his/her fellow YLIparticipants will be jeopardized.

In such event, the Student will not be eligible to participate in Friday’s graduation and receive certification ofcompletion of the program, nor be eligible to enter the post program Four - Way Test College ScholarshipEssay Contest for college scholarship money.

Student’s Signature Date Signed

Parent/Guardian’s Signature Date Signed

MAIL YOUR COMPLETED APPLICATION TO:YLI – 2015 Applications

Susan Keim, YLI Program Coordinator625 Indiana, Lawrence, KS 66044


YLI SCHOOL STAFF REPORT: Page 1 of 2 (Confidential)

This report should only be filled out by a faculty advisor or counselor.This form must be received by YLI before Student’s Application will be considered.

Student’s Name: _________________________________________________________Cumulative GPA: ___________

Please indicate Student’s grade classification for the 2014-15 school year:

Freshman____ Sophomore ____ Junior ____ Senior ____

Comment briefly on Student’s academic ability and application:

Comment briefly on Student’s suitability for this leadership program and his/her potential as a leader in his/her community in the future:


YLI SCHOOL STAFF REPORT: Page 2 of 2 (Confidential)

Student’s Name: _________________________________________________________________________________

Briefly list Student’s extra-curricular school activities (i.e. clubs, athletics):

Additional Comments:

Staff person’s name and title:

Signature:

Date:

High School:

Office Phone No.:

Email Address:

IMPORTANT:This Staff Report must be received by YLI before the

Student’s Application will be considered.If you would like to return this Staff Report separately,

please mail to:

YLI 2015 APPLICATIONS

Susan Keim, YLI Program Coordinator625 Indiana

Lawrence, KS 66044(816) 863-1144

Documents

YLI 2015 APPLICATION INSTRUCTIONS - Microsoft...2015 APPLICATION INSTRUCTIONS 1. This application should be received on or before May 1, 2015. Please mail completed applications to: