SAMPLE CLUB PRELIMINARY OUTBOUND APPLICATION
(Please read this before filling out the attached application)
The Rotary Club of __________________ participates in an educational and cultural youth exchange program for high school students. Under the program, you will live in a host country for approximately 10 months, attending high school and living with 1 – 4 host families. Students apply to become a Rotary Exchange Student at the end of their freshman year, or at the beginning of their sophomore year, and if selected will spend their junior year in the hosting country. You should think seriously about participating in the Rotary Youth Exchange Program, since it affords a wonderful opportunity for travel, study and adventure in a foreign country. This is a broadening experience for students of exceptional promise. Being a Rotary Youth Exchange Student is exciting and challenging, since you will see and learn about another country after living there for just a month or two. It is emphasized that you do not have to come from a family in which there is a Rotary member; everyone is welcome to apply.Exchanges have been conducted in the following countries: Argentina, Austria, Belgium, Brazil, Chile, Colombia, Czech Republic/Slovakia, Denmark, Finland/Estonia, France, Germany, India, Italy, Japan, Mexico, South Korea, Taiwan, Thailand and Turkey. These countries can change each year.
When chosen as a candidate, an application fee of $___________ will be required. Additional major expenses to you will be to provide your own airfare to and from your host country, insurance, and an emergency fund of $500. Other incidental expenses may also be involved, but the year abroad is a bargain, since your food and lodging will be provided by the host families. Some financial aid may be available for those with a demonstrated need. To apply for the Rotary Youth Exchange Program, please fill out an application and submit it to a
member of the Youth Exchange Committee as listed below. Your preliminary application must be submitted by _____________.
Key Dates:
- Complete and return Preliminary Application to the local club by ___________.
- Interviews with the local club during the period of ______________.
- Candidate nomination form postmarked, with check attached to District Outbound YE Coordinator by September 30th.
- Final applications postmarked to the District Outbound YE Coordinator by October 31st.
- The local Rotary Youth Exchange Committee consists of the following members:
Preliminary Application to local Rotary Club
ROTARY YOUTH EXCHANGE PROGRAM
Application to be completed by the student and submitted to the Rotary Club of ____________ for possible acceptance as an outbound student candidate for overseas placement in the Rotary Youth Exchange Program. (You may use the reverse side to complete answers.)
Previous page is for your information. Please return pages 2 & 3 when completed
Name: ________________________________________________________ Male Female
Complete address: ____________________________________________________________________________________________________________________________________________
Phone: _____________________________ Cell: ___________________________________
Date of birth: _______________________ Age: ____________________________________
Place of birth: _______________________ Citizenship: _________________________________
Parent’s (Guardian’s) name(s): ______________________________________________________
Address: (if different) ____________________________________________________________
Occupations: ___________________________________________________________________
Name of school you attend: _________________________________________________Location:_______________________________________________________________
Year in school: ______________________ Current GPA: ______________________________
Religion: ____________________________________________________________________
What are your school interests and activities? ______________________________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________________________
What are your hobbies and accomplishments (art, music, drawing, etc.)? ______________________________________________________________________________________________________________________________________________________________________
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Have you studied a foreign language? Yes No If yes, how many years, what language, and what degree of proficiency?
______________________________________________________________________________________________________________________________________________________________________
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Write a short paragraph on why you want to go to another country as a Rotary Exchange Student.
______________________________________________________________________________________________________________________________________________________________________
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Have you ever been away from home? If so, how long, to what destination, and for what purpose?
______________________________________________________________________________________________________________________________________________________________________
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Show your first, second, and third choice of areas. Asia, Europe or Latin America
1.. _________________________ 2. _________________________ 3. ___________________
Please have your parents sign here to indicate their willingness for you to participate in the Rotary Youth Exchange Program.
Mother/Guardian __________________________________________ Date _________________
Father/Guardian ___________________________________________ Date _________________
Student signature: __________________________________________
Date application completed: _________________________________
