Rotary Youth Exchange Interest Form
If you are interested in learning more about participating in the Rotary Youth Exchange please fill out this brief form. We will reach out in order to learn more about you and your exchange interests!

NOTE: This interest form is for students living in Rotary District 6560, which covers central Indiana. Click here for a map of District 6560. 

Please email our Outbound Coordinator with any questions! Amy Conrad: 6560rye.oc@gmail.com 
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First Name *
Last Name *
Email Address *
Date of Birth *
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/
DD
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YYYY
School Name *
Current Grade *
Parent/Guardian Name *
Parent/Guardian Email *
Parent/Guardian Phone Number *
What school year would you like to go on an exchange? *
Why are you interested in the Rotary Youth Exchange?
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