Wooster Rotary Youth Exchange District 6650
Student Interest Form
* Required
Let us know of your interest in Rotary Youth Exchange!
We will keep you informed of informational meetings and other YEX activities.
STUDENT INFORMATION
Full Name (first & last)
*
Your answer
Address
*
Your answer
Home Phone
*
Your answer
Cell Phone
Your answer
Email Address
*
Your answer
High School
*
Central Christian
Northwestern
Norwayne
Orrville
Smithville
Triway
Wooster
Other:
Grade in School
*
Your answer
Birthdate
*
Your answer
When do you want to go on Exchange?
*
Your answer
Parent or Guardian #1
EXAMPLE: This could be your mother's information...
Parent or Guardian #1 Name
*
Your answer
Parent or Guardian #1 Home Phone
*
Your answer
Parent or Guardian #1 Email Address
*
Your answer
Parent or Guardian #1 Cell Phone
Your answer
Parent of Guardian #2
EXAMPLE: This could be your father's information...
Parent or Guardian #2 Name
Your answer
Parent or Guardian #2 Home Phone
Your answer
Parent or Guardian #2 Email
Your answer
Parent or Guardian #2 Cell Phone
Your answer
Your Interest in Rotary Youth Exchange
Answer each in brief...
How did you learn about Rotary Youth Exchange?
Your answer
Briefly, why are you interested in Rotary Youth Exchange?
Your answer
Do you have any specific questions you'd like answered now?
Your answer
Would you be willing to host an exchange student for 3-5 months? Please let us know if we can provide you with more information.
Yes
No
Maybe
Give us any additional comments or questions...
Your answer
Submit
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