Instructions forPreliminary Outbound Student Application

Rotary District 5400 Long-term Youth Exchange Program

Thank you for your interest in the Rotary Youth Exchange!

The following provides information to help you take the first step in the process: completing the preliminary application.

General information for students and parents

  • This application form is important for us because we use the information provided in it to help us with our nomination and selection process.
  • You need to send your completed application to your local Rotary club. If you are not sure where to send it, see below.
  • Deadlines for these applications vary from one Rotary club to the next; however, most clubs will ask for these to be submitted by September 15, and preliminary interviews are completed by October 1. You should contact your club in early September to ask about their exact schedule for this year.
  • When a Rotary club nominates a student for exchange, the student then begins the District 5400 selection process, which includes students from across Southern Idaho and Eastern Oregon. This process includes an additional—and more comprehensive—application. It also inclues a one-day interview and selection event, which is typically held on the 1st or 2ndSaturday of November in Buhl, Idaho.

How to complete the preliminary application form (located below)

  1. Openthis file in Microsoft Word.
  2. Use ‘save as’ feature to save the file in a location where you can find it again later.
  3. Use the fillable form features to respond to the questions. Make sure to use correct grammar, capitalization, punctuation, etc. You want to make a strong first impression!
  4. When you are finished, save the file.
  5. Print a copy for you and your parent(s)/guardians and you to sign.
  6. Attach a photo to the front of the application.
  7. Deliver the completed applicationto your local Rotary club. Not sure where this is? See below.

NOTE: If you do not have access to this file electronically, or if Microsoft Word is unavailable, you can hand-write your application. If you do this, please make sure your writing is neat and easily readable.

Additional information

For additional information please see the Introduction to Rotary D5400 Youth Exchange document.

Not sure how to find your local Rotary club?
Check out club listings at
Or, you can contact a member of our district outbound team:

  • Tom Rosenthal, Youth Exchange Committee Chair: 208-863-4242 |
  • Mike Markley, Outbound Coordinator: 208.861.8879 |
  • Beth Markley, Outbound Coordinator: 208.484.4424 |
  • Nancy Chinn, Youth Exchange Administrator: 208.344.7070 |

Preliminary Outbound Student Application

Rotary District 5400 Long-term Youth Exchange Program

Smile!

Please provide
a recent photo
of yourself,

such as a school portrait

or a passport photo.

Your Full Name:
Street Address:
City, State, ZIP:
Your email address:
Your mobile number:
Home telephone:
Date of birth:
Your current school:
Grade-level:
What are your interests, activities, and hobbies?
What are your extracurricular activities at school?
Describe your past travel experiences:
Have you studied any foreign languages? If so, which language(s), and for how long have you studied?
Why do you want to become an exchange student? What do you hope to accomplish during and after?
Do your parents support your quest to become an exchange student? Why or why not?
Print Name
Mother/Legal Guardian / Signature / Date / Cell phone / Email address
Print Name
Father/Legal Guardian / Signature / Date / Cell phone / Email address
Print Name
Student / Signature / Date / Cell phone / Email address

Return this completed application form to your local Rotary club.

Questions?

Contact Tom Rosenthal at 208-863-4242 or Mike Markley at 208-861-8879

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Revised 06-Mar-16