Rotary Youth Exchange

Rotary Club Interview

Packet for Interested Students

·  Rotary Youth Exchange Application Procedure (first 2 pages)

·  Student Club Application Form for Club Interview (pages 3-4)...

·  School Reference Form Page 6– It says “Long Term” but also required for Short Term Applicants - Must be returned to your Rotary club Representative by the school representative by Nov. 1st.

See Directions on the form.

·  Host Family Recommendation page 7 Form to be completed and turned in with your Club application.

·  Self-Assessment - (page 5) for student’s own personal review and evaluation

For answers to questions please contact your sponsoring Rotary Club representative.

Rotary Youth Exchange Application Procedure

1. Student submits (typed) “Student Application Form for Club Interview” with 700-word essay (see club application form for requirements) and school reference form (found on a separate file) to local club representative

2. Inquire when Club Interview times will be assigned and communicated –a parent should also attend.

3. Then the local Rotary Club reviews Club Application Form and essay, interview scoring results, checks references, and makes recommendation to Rotary District 5890 Youth Exchange Committee.

4. Upon recommendation of the local Rotary Club, the District Committee or club representative provides the District Rotary Youth Exchange LONG-TERM or SHORT-TERM Application via email to the student.

5. Student passing the club interview will be informed by Rotary Club representative and will submit the completed District LT Application or District ST Application which should be received by the District Rotary Committee by Nov 25. (Plan ahead due to Thanksgiving Vacation) Included with the application, the candidate is again to identify the names and contact information for 3 candidate host families that they have contacted and who have agreed to be considered and to have an informative conversation with the Club Youth Exchange Officer.

If submitting the District Application by mail, the application should be sent to:

Alan Wylie (long term) Mike Strobel (short term)

439 Shadow Creek Dr. 312 Oyster Creek Dr

Seabrook, TX 77586 Lake Jackson TX 77566

281-851-1932 281-450-9807

and let them know by telephone that the application is in the mail.

6. District interviews will be conducted on December 5-6 (Sat. and Sun.), in Houston, which may also be one of the dates for SAT tests, so applicants should arrange their SAT test for another date. Attendance at the District Interview is mandatory for all applicants and at least one parent. YOU MUST BRING WITH YOU Original signed APPLICATIONS, each with original signatures and original pictures. (These include signatures from you sponsoring Club.)

7. Following the District interviews, the Rotary district committee will review all applicants and inform them within one –two weeks whether or not they have been selected for continuation into the youth exchange program. (Note: A student is not formally accepted as an exchange student until successful completion of 4-day orientation camp in JUNE, 2016.)

8. The Rotary District committee will work with the applicants for arranging their exchange with another country. It is important to recognize that the student's top 5 preferences for a country will be considered, but factors may prohibit any of the 5 selections from being realized.

9. Countries with whom we are currently working youth exchange:

Belgium Sweden Poland ? Argentina Japan

Germany Denmark Turkey Brazil Thailand

Italy The Netherlands Taiwan

France Paraguay Bolivia

(South America, Japan, Thailand, Poland, Turkey are LT only)

(Spain, England, Austria - ST only)

Please note estimated costs and times of payments - Fee and Dates are subject to change:

Long-term exchange is estimated $5,000 ($1000 Dec. 5th, 2000 January, $2000 March.)

Short-term cost estimation is $2,000. ($100 due Dec. 5th, $200 due March, Air tickets costs due May 1st, and entertainment Mid June-Mid August.

.

9. Upcoming significant meetings and activities

November 1 Deadline for submitting club application to local Rotary Club

November 7 Humble Rotary Club Interviews - time & Place will be emailed.

November 25 Deadline for submitting District LT & ST application

December 5-6 District 5890 interviews & overnight beginning at 9:00 AM on Sat.

January Orientation #1 for long-term students and parents (mandatory)

March Interact District Conference

March Orientation #2 for long-term students and parents (mandatory)

March Orientation for short-term students and parents (mandatory)

Late June Orientation camp (4 days) for long-term students (mandatory)

Mid June – Mid August Short term exchange (4 weeks maximum each country)

August Departure for long-term students “year of a lifetime”

10. For more information or questions, please contact local Rotarian, or district representative Alan Wylie, at 281-851-1932 (cell), or . For short term, contact local Rotarian or district representative Mike Strobel at 281-450-9807 (cell) or

SEE NEXT 2 PAGES FOR CLUB APPLICATION


ROTARY YOUTH EXCHANGE

Student Application Form for Club Interview

District 5890

Application is to be typed and completed by the student and submitted to a Rotary Club for possible acceptance as a candidate in the Rotary Student Exchange Program. Students accepted at the club level will be interviewed subsequently at the Rotary District level.

On Rotary Applications: Last Names are always in CAPITALS, dates written as example: “30/Oct/2013”

NAME ______Date ______

Address ______

______Student’s Cell Phone ______

Home Phone # ______Date of Birth ______

Age, as of Aug 1, 2015: ___Year___Months

Email Address: ______

Information on Father Information on Mother

Name ______Name______

Address ______Address______

______

Occupation ______Occupation ______

Rotarian Yes _____ No ______Rotarian Yes _____ No ______

Home Phone # ______Home Phone #______

Cell Phone Number______Cell Number______

Email ______Email ______

*Social Security # ______*Social Security #______

*Social Security numbers are required only for the parents of Short-Term applicants because they will host the inbound exchange partner. These social security numbers are necessary to conduct criminal background checks.

Page 2

STUDENT INFORMATION

Student name:______

School Attending ______Location ______

Are you in the upper one-half or third of your class? ______Yes ______No

Current Classification in School ______(Sophomore, Jr., Sr.)

School Interests / Activities: ______

______

Hobbies / Accomplishments/ Service Activities: ______

Important Medical Question: Are you being treated for depression? ___Yes ___No

Foreign language experience (language, number of years, proficiency)

Other Referrals: (Preferably one or more Rotarians)

Name Association Rotarian? Phone Numbers

1. ______

2. ______

3. ______

Include a 700-word essay, relating to: “Why I would be an Excellent Ambassador for My Country and for Rotary” Circle “yes” to verify essay attached.

Country Preferences:1. ______2. ______3. ______4. ______5. ______

Youth Exchange Program of Interest: Short Term ___ Long Term ______

Signatures should be in blue ink, dates written as example: “dd/Oct/2013”

Student Signature: ______Date: ______

Parents’ Signatures, indicating their willingness that student applicant participate in Rotary Youth Exchange Program.

Father ______Date: ______

Mother ______Date: ______

Sponsor: Rotary Club of Humble______Rotarian’s Name ______

Scan & email Club Application & essay to local Rotary Club Sponsoring you by November 1, 2014:

Club Interviews - you will be assigned a date and appointment time.

ROTARY YOUTH EXCHANGE

Self-Assessment

The following is a self-assessment that you can take to see if Rotary Youth Exchange is the right thing for you:

-Do you enjoy experiencing new situations and adapt to them quickly?
-Are different foods something you enjoy?
-When you go to a new place, do new friendships start almost immediately?
-Do you view the world from an optimistic perspective?
-Is being around new people much more enjoyable for you than being alone?
-When you meet someone, do you listen carefully to learn about them?
-Can you follow the appropriate rules when faced with a different situation?
-Are you able to think through problem situations and make your own decisions?
-Have your grades been in the upper half to one third of your class?
-Do you want to learn or improve your proficiency in a foreign language?
-Will you be age 15 to 18 1/2 at the beginning of the next school year?
-Are you in good health? Are you not being treated for depression?
-Do you enjoy service to others through school and community activities?
-Would you enjoy representing your community, state, country and culture as a youth ambassador in a foreign country?
-Are you interested in learning about other countries and cultures?
-Do you enjoy being with others who have very different customs and beliefs?


-Would following the Rotary 4-Way Test to make decisions for everything you think, say and do be easy for you?

The Rotary 4-Way Test

 Is it the Truth?

 Is it Fair to All Concerned?

 Will it Build Goodwill and Better Friendships?

 Will it be Beneficial to All Concerned?

If you sincerely answered YES to all of the above, CONGRATULATIONS, you probably have the right stuff to be a Rotary International Youth Ambassador in the Rotary Youth Exchange Program!

Students: Please fill in the name and address of your Rotary Club’s representative so the teacher or school official can send this completed form to them.

Rotary Youth Exchange -Long-Term& Short Term Exchange Program

Section H: Secondary School Personal Reference

Student: Complete the top section of this form, and then give the form and a stamped envelope, preaddressed to the Rotary club or district to which you arc submitting your application, to a teacher or administrator who knows you and your abilities and accomplishments at school. By so doing, you give permission to that individual to release this information to the Rotary club/district Youth Exchange committee for their review

Applicant’s Full Legal Name Date of Birth Grade O

Male

D Female

Evaluator: This student is applying for a one-year educational study abroad program under Rotary club/district sponsorship. Please complete and forward this form within seven days of receipt in the preaddressed envelope provided. The information you submit will not be revealed to the student, unless required by law.

1. Ratings

Area / Excellent / Good / Average / Bet Average / No Basis o Rate
Creative, original thought
Independence, initiative
Intellectual ability
Emotional stability
Academic achievement
Openness to new ideas
flexibility , adaptability
Ability to communicate
Potential for growth
Disciplined habits
Participation

2.  Do you bel eve the applicant has the ability, work habits, character traits, and flexible ty to succeed in an unfamiliar environment that will include

3.  learning a foreign language? Yes No

4.  Do you believe the applicant's parents/legal guardians support his/her wish to spend time abroad? Yes No Not-Sure

Please use the reverse side of this form, adding pages if necessary, to explain your answers to questions 2 and 3, and to provide any additional comments on the applicant’s suitability as an exchange student and cultural ambassador.

Name and Title (type or print) / Signature (in blue ink) Date (e.g . . . 25! /anl20()8)
I
Name of School / Phone / E-mail

Rotary Youth Exchange Program: Personal Reference Section H, Page I ofl

Host Family Recommendation Form

for Hosting Students Coming to Houston

from Other Countries

Note: The following suggested host families who live in your high school attendance zone are to be submitted along with the club application. If they are interested, you may list your own family as one of the possible host families.

Student’s Name: ______

Student’s home ph.: ______Cell ph.: ______

Student’s High School: ______

Family No. 1:

Dad’s name: ______Mom’s name: ______

Street Address: ______

City: ______Zip Code: ______

Home Phone: ______

Number of children in the family: ______Ages of children: ______

School District: ______

High school incoming student will attend: ______

Family No. 2:

Dad’s name: ______Mom’s name: ______

Street Address: ______

City: ______Zip Code: ______

Home Phone: ______

Number of children in the family: ______Ages of children: ______

School District: ______

High school incoming student will attend: ______

Family No. 3:

Dad’s name: ______Mom’s name: ______

Street Address: ______

City: ______Zip Code: ______

Home Phone: ______

Number of children in the family: ______Ages of children: ______

School District: ______

High school incoming student will attend: ______

Please note: Host families listed above must live in your high school attendance zone.