RYL 2010 Application
INSTRUCTIONS
  • Please complete each section in full and print
  • Application must then be signed by the principal, parent/guardian and student.
  • Send completed application to:
    Attention: Joni Huffmyer.
    Regional Youth Leadership
    Northern Kentucky Chamber of Commerce
    PO Box 17416
    Ft. Mitchell, KY 41017-0416
  • Application must be postmarked no later than March 20, 2009.
  • Call or email questions to Joni Huffmyer at (859) 578-6398
  • All questions must be completed for the application to be accepted.
PROGRAM SELECTION
  • Participation in Regional Youth Leadership is open to those students living in the Northern Kentucky and Greater Cincinnati area who will be juniors in the 2009/2010 school year.
  • The Regional Youth Leadership Selection Committee, based on the information completed on the application, will select participants. The committee will be seeking representation from a cross-section of the community.
  • Applicants must have the full support of the school they represent and their parent/legal gaurdian.
  • Attendance at all of the sessions is expected. Excused absences include illness and/or school commitment. It is MANDATORY that you attend the Orientation and the Opening Retreat. Please check the tentative session dates. This will give you an idea of the commitment that you will be making from August 2009 to March 2010.
  • All applicants will be notified of selection by April 24, 2009.
Last Name*
First Name*
Middle Name:
Name for Name Tag
Home Address*
City*
State*
Zip*
Home Phone*
Cell Phone
Home E-mail
School
School Contact
School Phone
School E-Mail
OPTIONAL PERSONAL DATA
(this information is helpful in assuring a diverse class)
Sex
Date of Birth
Ethnic Background
ACTIVITIES
List up to five school activities in which you have participated during the last four years.
High  School
Name of Club/Organization/Sport
Years
Your Role
Name of Club/Organization/Sport
Years
Your Role
Name of Club/Organization/Sport
Years
Your Role
Name of Club/Organization/Sport
Years
Your Role
Name of Club/Organization/Sport
Years
Your Role
List up to five non-school related activities in which you have participated during the last four years.  
Name of Club/Organization/Sport
Years
Your Role
Name of Club/Organization/Sport
Years
Your Role
Name of Club/Organization/Sport
Years
Your Role
Name of Club/Organization/Sport
Years
Your Role
Name of Club/Organization/Sport
Years
Your Role
If you haven't had the opportunity to participate in such activities, why not?
Time
Not Interested
Work
Financial Reasons
Other
What is your main interest of studies?
QUESTIONS (If working offline, you may type answers on a separate sheet and attach.)
If you could have dinner with anyone, living or deceased, who would it be and why?
In your opinion, what responsibility do youth have to help solve community problems?
If you could change anything in our Greater Cincinnati/Northern Kentucky region, what would it be and why?
Why do you want to participate in Regional Youth Leadership?
PARENT/GUARDIAN PERMISSION
Student Name:
School:
I have read the information on Regional Youth Leadership and am willing to have my child participate. I understand it is my responsibility to provide transportation for my child to and from the sessions with exception of the retreat. A bus will be provided to transport students to the retreat site. In the event that transportation is required during a session, Regional Youth Leadership, its agents, and its employees have my full permission and consent to transport my child by public school bus, private automobile, vans or other appropriate means of transportation.

I hereby release and hold harmless Regional Youth Leadership, its members, its agents, employees or any individuals involved in planning, organizing or presenting programs, for any accident, injury, illness or any damage whatsoever related to the above-mentioned student's attendance at or participation in any activity or session of Regional Youth Leadership.

I hereby grant Regional Youth Leadership permission to photograph my child and to publish the photos in connection with the advertisement of RYL including without limitation brochures, portfolios, flyers, catalogues, compact discs and websites.
Signature of Parent/Legal Guardian:
Print Name:
Date:
Home Phone:
Work Phone:
Cell Phone:
Email:
Emergency Contact:
Emergency Contact Phone:
SCHOOL PERMISSION
All applicants MUST have the approval their school principal to attend sessions of Regional Youth Leadership. Please have your principal sign below.
I approve the participation of
in Regional Youth Leadership for the 2009/2010 school year.
Principal Name:
School:
Principal Signature:
Date:
ATTENDANCE
If selected, you commit to attend the program orientation, the opening retreat, each one of the seven program sessions and graduation. Full attendance by each participant is essential if Regional Youth Leadership is to meet its objectives. Regional Youth Leadership will work with schools to encourage school attendance credit. Please check the session schedule. I understand and accept the attendance requirements for Regional Youth Leadership.
Student Signature: _______________________________________________
Date:
T-Shirt Size (for Retreat):
Other:

  

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