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Arrival Report Form

Outbound Student Arrival Report Form
To: Youth Exchange District 9450 Chairman

IMPORTANT: This Form MUST be completed within two weeks of your arrival in your host country. Complete the Form with ALL possible details that are known to you. In particular you need to confirm the name and address of your first host family and your host mentor’s details if you have them.

To submit the Form, simply fill in the details to the best of your knowledge and click the “Submit” button. The Form will be e-mailed to the District 9450 Youth Exchange Chairman.

Student Name:

Student E-mail:

Date of Arrival:

Sponsor Rotary Club in Australia:

 

 

 

Details of First Host Family

 

Host Family Name:

Host Family Address:

Host Family Telephone Number:

Host Family Email:

School to be Attended:

Expected Class, Grade or Form at School:

Student Interview with Principal on:

Probable Number of Host Families During Exchange:

Has Pocket Money (allowance) by Club been Commenced? Yes     No

If Yes, how much money monthly?

Has Emergency Fund been banked in Joint Names
of Student and Counsellor? Yes     No

Has Hospital/Medical Insurance been arranged? Yes     No

If Yes, provide brief details:

Has evidence of US$10,000 life insurance been shown? Yes     No

If No, are arrangements being made for this to be done? Yes     No

 

Details of Host Club and Mentor

 

Host Rotary Club:

Country of Exchange:

Host Club District:

Host Mentor’s Name:

Host Mentor’s Address:

Host Mentor’s Phone Number:

Host Mentor’s Email:

 

Finally, were any difficulties experienced in your travel en-route or in being met on arrival?

 

After completing as many fields as you can, click on the “Submit” Button to e-mail this report to the District 9450 Chairman. You will be transferred immediately to a confirmation webpage if you have successfully sent your report.

 

  

The Western Australian Rotary Youth Exchange site emcompasses Rotary Youth Exchange for the WA Rotary District 9455.
Your feedback regarding this website is welcome and can be sent to contact@youthexchange.asn.au