Application Download Application Instructions Please enable JavaScript in your browser to complete this form.1Contact Information23Leadership Roles, Activities, & Honors4Leadership Essay5Submit*Please have your leadership essay ready to upload when you fill out this application. Instructions for the leadership essay can be found by downloading the Application Instructions above.Chapter Name *Select your chapterAZ - Scottsdale Rotary ClubIA - Cedar RapidsIA - DubuqueIA - Iowa CityIA - North CentralIN - MuncieIN - Randolph CountyKY - Central KentuckyKY - Lincoln Trail ElizabethtownNE/IA - Omaha NE - Council Bluffs IAOH - Pickaway CountyOtherSTOP! Fill out the application for Central KY Youth Salute at www.centralky.youthsalute.comNextSchool Name *Student Contact Information Student Name *FirstLastStudent Home Address *City *State *Zip *Student Phone Number *Student Email *EmailConfirm EmailA copy of your application will be sent to the email address entered here.Parent/Guardian Contact InformationParent/Guardian Name - Primary *FirstLastPhone Number - Primary Parent/Guardian *Email - Primary Parent/Guardian *EmailConfirm EmailParent/Guardian Name - SecondaryFirstLastPhone Number - Secondary Parent/GuardianEmail - Secondary Parent/GuardianEmailConfirm EmailPreviousNext2 QUALIFYING LEADERSHIP ROLESStudents must have held or currently hold 2 leadership roles to which they were chosen by their peers or an adult leader within the past two years in school, religious or community sponsored organizations. Spell out complete names of clubs and organizations, no abbreviations. QUALIFYING LEADERSHIP ROLE 1 (Organization/Role/School Year) *QUALIFYING LEADERSHIP ROLE 2 (Organization/Role/School Year) *ADDITIONAL LEADERSHIP ROLES, ACTIVITIES, & HONORSUse the fields below to LIST all other leadership roles, activities, and honors you would like the committee to know about. You may enter (and we encourage) multiple items per field. Fields may be left blank if they do not apply to you.SCHOOLSTATE/NATIONALVOLUNTEER SERVICESPORTSCOMMUNITYPreviousNextUpload your Leadership Essay * Click or drag a file to this area to upload. PreviousNextHow did you hear about Youth Salute?... *School CounselorTeacherSchool AnnouncementSigns at schoolFriendFamilyDo you have a sibling that participated in Youth Salute in the past? *YesNo = Website / URLPreviousCommentSubmit