DISTRICT 6540 ROTARY YOUTH EXCHANGE
HOST CLUB COMMITMENT
INBOUND - LONG TERM EXCHANGE
The Rotary club of ______agreesto make a commitment to host an inbound exchange student (Long Term) for the 2014-2015school year. We agree to meet the financial obligations of Central States Rotary Youth Exchange and abide by the rules of the program.
This form should be completed in duplicate (2 copies), one copy to be retained by the Rotary club and one copy sent to:
Lynda VanScoik – Inbound Coordinator
3655 Bent Oak Trail
Elkhart, IN46517
574-304-7229
Our Rotary club has the following preferences for inbound student, ALTHOUGH WE UNDERSTAND THAT THERE IS NO GUARANTEE OF THESE CHOICES:
Boy ____ Girl ____
YOU MUST ENCLOSE YOUR CLUB CHECK IN THE AMOUNT OF $1050 FOR THE 2014-2015COMMITMENT. YOUR COMMITMENT WILL NOT BE CONSIDERED UNLESS YOUR CLUB CHECK ACCOMPANIES THIS FORM.
Special Discount – Send this in with your check before November 30,2013 and the amount is only $850!
This fee includes purchase of a student group, host family liability package, administration expenses for Multi-District (Central States), attendance of student at 4 weekend conferences, and the Calvin Collegeconference held at the end of the exchange year. Failure to accept a student after submitting this form will result in forfeiture of the application fee. Additionally, your club may be held responsible for additional fees if D6540 is unable to place the student with another club in our district.
Date: ______
President’s Name:______
Address: ______
City: ______State: ______Zip: ______
Telephone: ______Fax: ______
Work Phone: ______Email:______
Youth Exchange Officer (YEO):______
Address: ______
City: ______State: ______Zip: ______
Telephone: ______Fax: ______
Work Phone: ______Email:______
The District Youth Exchange committee thanks you for hosting and parents and youth from around the world thank you for the opportunity to spread good will and friendship.