Wooster Rotary Youth Exchange District 6650
Student Interest Form
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) *
Address *
Home Phone *
Cell Phone
Email Address *
High School *
Grade in School *
Birthdate *
When do you want to go on Exchange? *
Parent or Guardian #1
EXAMPLE: This could be your mother's information...
Parent or Guardian #1 Name *
Parent or Guardian #1 Home Phone *
Parent or Guardian #1 Email Address *
Parent or Guardian #1 Cell Phone
Parent of Guardian #2
EXAMPLE: This could be your father's information...
Parent or Guardian #2 Name
Parent or Guardian #2 Home Phone
Parent or Guardian #2 Email
Parent or Guardian #2 Cell Phone
Your Interest in Rotary Youth Exchange
Answer each in brief...
How did you learn about Rotary Youth Exchange?
Briefly, why are you interested in Rotary Youth Exchange?
Do you have any specific questions you'd like answered now?
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.
Clear selection
Give us any additional comments or questions...
Submit
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