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Forms

Inbound and Outbound Forms

Quarterly Report Forms

On The Web (Recommended)

In Word

In PDF

Youth Exchange Program Insurance Forms (Updating as of Mar.23rd 2011)

ACE Medical Claim Form Instructions

ACE Medical Claim Form (Submit to health care provider at time of service in ALL cases)

2011-12 Insurance Requirements for Inbound Students

2011-12 Insurance Requirements for Outbound Students

2011-12 Description of ACE Accident & Sickness Policy

2011-12 Description of ACE Personal Liability Policy

2010-11 Insurance Requirements for Inbound Students

2010-11 Insurance Requirements for Outbound Students

2010-11 Description of ACE Accident & Sickness Policy

2010-11 Description of ACE Personal Liability Policy

The Short Term Program - A Summer Abroad

Short Term Information Flyer

Short Term Pre-Application

Short Term Full Application

Long Term Programs - A Year Abroad

You are welcome to download the long term application form (long format) in its entirety. However, if a Rotary Club hasn't yet selected you, do not fill out the form. If you have any questions, please contact the Youth Exchange District Committee Member nearest you.

Rules and Conditions of Exchange

Long Term Application - Short Form

Long Term Application - Long Form

Outbound Student and Counselor Contract & Checklist (Word)

Outbound Student and Counselor Contract & Checklist (PDF)

Host Family Forms

Host Family Application

District 5130 Gift Pin Order Form

In Word

In PDF

Sexual Abuse and Harrassment Information

Youth Exchange Program Abuse and Harassment
Prevention Policy for District 5130 (Word)

Youth Exchange Program Abuse and Harassment Prevention Policy for District 5130 (PDF)

Youth Service Volunteer Affidavit & Waiver (PDF)

Frequently Asked Questions (Word)

Frequently Asked Questions

Live Scan Application (PDF)

Contact District Chair Glenda Sales: ye5130@sonic.net
707-545-4127(h) 707/544-0472 x14(wk) 707-486-6773(Cell)

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