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

Please allow at least 5 days for District Approval.

Inbound Student Full Name *
First and Last Name
Your answer
Inbound Student Cell Phone Number
USA Cell Number
Your answer
USA Rotary Club Name *
Your answer
YEO/YEC Name *
First and Last Name
Your answer
YEO/YEC Phone Number *
Your answer
YEO/YEC Email Address *
Your answer
Travel Dates *
Dates you will be traveling out of state.
Your answer
Destination *
Where are you going?
Your answer
Purpose of the Trip *
Your answer
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
Your answer
Phone Number of Person Above *
Cell Phone
Your answer
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?
Name of person completing this form *
Your answer
Email address of person completing this form *
Your answer
Submit
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