Youth Leadership Institute

Sponsored by:
Overland Park Rotary Club Foundation
Johnson County Community College

Nomination Form

Since many high school students don't imagine spending a week of their summer at a leadership camp, we rely on the community to nominate promising students to attend. Knowing an adult or one of their peers believes in them can spark a teenager to act, inspire a change and elevate their self esteem. The YLI staff will follow up with each nominee individually to encourage application to the program.

Each nominee will by notified by our YLI Program Coordinator of his or her nomination to participate in this prestigious activity. Each nominee will receive an information packet and application. Applications are reviewed in the order received, and are due by May 1st.

Tuition Assistance

If students cannot afford the full tuition cost of $195, they may apply for financial aid in the form of a grant from the Overland Park Rotary Foundation. Parents should submit a request, in writing, to the YLI Program Coordinator. The request must include an explanation of the need for financial assistance.

Susan Keim
YLI Program Coordinator
PO Box 7558
Overland Park, KS 66207

Part 1: Nominator's Information

Part 2: Nominee's Information

Nominee:

Relationship

High School:

High School Year

Address:

City:

State

ZIP Code:

Email address:

Phone number:

Mobile number:

Part 3: Nominee's Family Information

Name #1:

Relationship #1:

Email address #1:

Phone #1:

Mobile #1:

Name #2:

Relationship #2:

Email address #2:

Phone #2:

Mobile #2: