Rotary Club of St. Albert - Rotary Youth Exchange Application
Contact information: Jeri Featherley jfeatherley@shaw.ca / Charlene Zoltenko charlene.zoltenko.gbgy@statefarm.com
First name *
Your answer
Last name *
Your answer
Address *
Include city and postal code (e.g. 10 Sesame Street, St. Albert, AB T8N 1A3)
Your answer
Student mobile phone number *
Use format 780-123-4567
Your answer
Student email *
Your answer
Current School *
Your answer
Grade *
Date of Birth *
MM
/
DD
/
YYYY
Parent / guardian name(s) *
Your answer
Parent / guardian email address
Your answer
Parent - guardian phone number
Your answer
Do your parents support you in your quest to become an exchange student *
Your interests, activities, hobbies: *
Please describe
Your answer
Your past travel experience:
Your answer
Have you ever been away from your family for an extended period of time? (Over two weeks) *
Describe your experience
Your answer
Describe why you wish to become an exchange student: *
Your answer
What do you hope to accomplish during and after your exchange? *
Your answer
List any languages you have studied and indicate your fluency *
Fluency: 1=poor 2=marginal 3=short sentences 4=fluent
Your answer
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.
Your answer
Is there anything that could possibly affect your success on a one-year exchange?
Your answer
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. *
Your answer
List in order of their importance the four major issues facing Canada today. Why are they important? *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms