Youth Exchange Travel Request Form | Rotary International District 6460

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? *

Rotary Club *

Club President's Name *

Club President's Phone Number (Cell) *

YEO (or Other Rotarian) Give Permission? *

Did the Host Family Give Permission? *

Did the Biological Family Give Permission? *

Is the Student Making an Effort at School? *

Is the Student Behaving Within the Standards of Rotary *

Other Notes:

Rotary District 6460 Youth Exchange Travel Request Form