Outbound Preliminary Application
For students interested in spending one year abroad during high school.

If you are interested in this exciting and meaningful program, simply complete the preliminary application. Your local Rotary Club will contact you to set up an interview and answer questions.

To obtain further information about The Rotary Youth Exchange program, go to www.csrye.org or contact Toni Pabon at 608-628-7306, toni.pabon@charter.net.

Student's Name (First and Last) *
Your answer
Student's Street Address *
Your answer
City *
Your answer
State *
Zip Code *
Your answer
Student's Email Address (do not give a school account email address) *
Your answer
Cell/Home Phone Number (with Area Code) *
Your answer
Name of High School you are attending *
Your answer
Current Grade *
GPA Average is based on the last 2 academic school years. A minimum of 2.75 GPA or student ranking in the top 50% of class is needed to be accepted into the program.
Average GPA (Grade Point Average) *
Your answer
Must be born on or after FEB 1, 2001 AND must be born on or before FEB 1, 2004.
Date of Birth *
MM
/
DD
/
YYYY
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service