I certify that all statements made by me on this application are true to the best of my knowledge, and that I have not withheld any information that would, if disclosed, affect my application unfavorably.

I have read the Rotarian Experience Participant Description and I can, with reasonable accommodation, perform what I believe to be the essential elements of the position for which I am applying.

I understand and accept the principles of the Rotary Youth Leadership Awards Conference as expressed in its purpose.

I agree to submit myself for a formal background check as sanctioned by Rotary District 6220 and understand that the results of which may impact my eligibility to participate in the leadership experience.