Rotary D6250 Youth Exchange Travel Request
TRAVEL REQUEST - INBOUND STUDENTS
FOR OVERNIGHT TRAVEL OUTSIDE OF STATE

This form should be completed by the Inbound Student. It must be completed at least 5 days ahead of the departure date.

To complete the form you will need the following information. Collect it before beginning and make sure to accurately enter the email addresses; errors will require you to resubmit the entire form.

  1. Your YEO's name and email
  2. Travel dates and destination
  3. Adult you will be traveling with
We will make a decision on your request within 5 days of receiving it. Do not travel without receiving the approval.
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Email *
Inbound Student's First and Last Name *
Inbound Student's USA Cell Phone Number
 *
USA Rotary Club Name *
YEO First and Last Name *
YEO Email Address *
** Double check the accuracy of this email address as the YEO will receive and review your request. **
Travel Dates:  *
Dates you will be traveling out of state.
Is the destination outside of the U.S.A?
(International travel requires extra review time to ensure your Visa will allow you to re-enter the USA.) *
Travel Destination: *
Where are you going? City & State
Purpose of the Trip *
Is this a school trip? *
Has your school been notified about your absence? *
Are you traveling with your host family? *
Person in Charge *
Adult traveling with you - First and Last Name
Cell Phone Number of Person Above *
Do background checks need to be completed?  *
Background checks are required for any adult who will be alone with you for a period of time. 
If you answered YES above...Have background checks been completed? *
Additional Details 
Feel free to add details here that will help us understand your travel request. This is most important if your travel will be with someone other than your host family. Remember, our main goal is to understand if you will be safe during the travel. Once we have enough detail to be confident of your safety, we will be able to approve your request. 
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