Rotary Club of St. Albert - Rotary Youth Exchange Application
Contact information: Laszlo Szojka - laszlos@shaw.ca / Anthony Porter - arporter@shaw.ca
First name
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Last name
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Address
Include city and postal code (e.g. 10 Sesame Street, St. Albert, AB T8N 1A3)
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Student mobile phone number
Use format 780-123-4567
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Student email
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Current School
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Grade
Date of Birth
MM
/
DD
/
YYYY
Parent / guardian name(s)
Your answer
Parent / guardian email address
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Parent - guardian phone number
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Do your parents support you in your quest to become an exchange student
Your interests, activities, hobbies:
Please describe
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Your past travel experience:
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Have you ever been away from your family for an extended period of time? (Over two weeks)
Describe your experience
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Describe why you wish to become an exchange student:
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What do you hope to accomplish during and after your exchange?
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List any languages you have studied and indicate your fluency
Fluency: 1=poor 2=marginal 3=short sentences 4=fluent
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What was your overall average in all courses in your last school year (2015-16).
If you are selected for the next round of applicants, you will have to provide a transcript from your school.
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Is there anything that could possibly affect your success on a one-year exchange?
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Describe what you expect to contribute to the Rotary Youth Exchange program, to your host families, and to the country you will be living in. Also explain what you expect to gain from participating in this exchange.
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List in order of their importance the four major issues facing Canada today. Why are they important?
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