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Rotary Youth Program of Enrichment (RYPEN) Camp Application
Section One:  Personal Information
Name: ____________________________________________________       Date of Birth: ____________
Address: ___________________________________________________       Postal Code: ____________
Telephone #: (         ) _____________________________           E-mail: ______________________________
Current Grade:  _____________________
Section Two:  Reason for Applying
Attach a short rationale (200 words or less) why you want to attend the camp and what you want to get out of the experience.
Section Three:  Community Service
List any community service or volunteer school activities in which you have been involved.
Name of community/school organization or club                               When                    What you did
Section Four:  Letters of Reference
  • Attach two letters of reference to this application
  • Letters should include comments on applicant’s personal qualities and service activities.
__________________________________________________           ___________________
Applicant Signature                                                                                                        Date
__________________________________________________           ___________________
Parent/Guardian Signature                                                                                         Date
Please forward your completed application to the Interact Teacher Supervisor.
Interact Teacher Supervisor Signature: ______________________________________
Supervisor Signature indicates that the applicant is a student in good standing within the school community and would be a suitable representative of Harry Ainlay School and the Rotary Club of Edmonton Gateway.