Preliminary Club Application Form: Rotary Internatoinal District 9300 Youth Exchange Program
Long Term Programme
12 months from January
Short Term Programme
6 Weeks from early December
PLEASE NOTE:
Students must be between the ages of 15 and 17 when they depart.
Applying for
Long Term
Short Term
Both
District
District 9300
District 9350
Full Name
Email Address
Physical Address
Home Telephone Number
Father's Telephone Number
Mother's Telephone Number
Fax Number
Date Of Birth
(Day/Month/Year)
Age On 31st December
(Years And Months)
Father's Name
Father's Occupation
Mother's Name
Mother's Occupation
Brother's And Sister's (Give Names & Ages)
School Attending Now
What Grade Are You In
Academic or Sporting Achievements (List briefly):
List in order of importance the four major issues confronting the world today
List in order of importance the four major issues confronting South Africa today
Give your reasons for wanting to become a Rotary Exchange Student and what you feel you will gain from a year in a foreign country and what you feel you will be able to contribute, via the exchange programme, towards promoting International Understanding and Goodwill between Nations, in an essay of not less than 250 words.
Do you have permission from your parents to apply
yes
no