2018-19-Preliminary Registration for RYEd6630 Short & Long Term Programs
Welcome to the beginning steps in the Rotary International District 6630 Youth Exchange Short Term Program and Long Term Scholarship Program.

If you are a student, please read further about your programs of interest. But, before you begin the actual online application process and to place you in our database to receive updates on the District's application processes, please provide us with some information about you so we can let you know if you have the minimum qualifications to apply. There are 22 questions, 10 of which must to be answered in order to submit this form.

Also, for the most current information about District 6630 Youth Exchange Scholarships please continue to come back to this Rotary District 6630 website and click on the "Youth Exchange" logo

Thank you for your interest.


Interest *
Are you interested in the year long scholarship or the two month summer program
Last Name *
Your answer
First Name *
Your answer
Email Address *
What email address do you check regularly? This is our primary communication tool. You should have your own and should check it regularly.
Your answer
What is your personal Cell phone number?
Your answer
If you text, what cell number or messenger service name do you use and check most often?
Your answer
Home Phone
Your answer
Rotary Club
If you already know it, what is the Name of your local Rotary Club?
If you have already been in contact with a Rotarian, please provide their name
Your answer
Mother's Name
Your answer
Mother's Cell
Your answer
Mother's Email
Your answer
Father's Name
Your answer
Father's Cell
Your answer
Father's Email
Your answer
Parents' Attitude *
Do your parents support your interest in becoming an exchange student?
High School Name *
If you are home schooled, just write "Home School"
Your answer
HS Type
What type of High School do you attend?
Grade *
What grade are you currently in? (School year 2016-2017)
Sch District *
What Public School District do you reside in?
Your answer
City *
What Municipality or Township do you reside in?
Your answer
Age *
Where you born "before" or "after" March 7, 2000
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.