Rotary District 6460 Youth Exchange Travel Request Form If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required Who is Completing the Form? * Email Address * Student Name * Destination City * Start Date of Travel * End Date of Travel * Name of Destination Hosts/Hotel/Place * Address of Destination Hosts/Hotel/Place * Phone of Destination Hosts/Hotel/Place * Contact Phone of Destination Hosts/Hotel/Place * Travel Arrangements: Driver Name * Travel Arrangements: Driver Cell Number * Is Travel By Other Means? * Yes No Rotary Club * Club President's Name * Club President's Phone Number (Cell) * YEO (or Other Rotarian) Give Permission? * YesNo Did the Host Family Give Permission? * YesNo Did the Biological Family Give Permission? * YesNo Is the Student Making an Effort at School? * YesNo Is the Student Behaving Within the Standards of Rotary * YesNo Other Notes: