(C) SENDING CLUB AND DISTRICT ENDORSEMENT
The Rotary Club of and District , Name of Club Club ID # District #
Club President Name Signature
Date (e.g., 01/Jan/2006) Home Phone E-mail
having interviewed the applicant and his/her parents/legal guardians and
reviewed the student’s application, hereby endorse the student as qualified for
Rotary Youth Exchange and recommend to host clubs the acceptance of this
student. District agrees to provide adequate orientation to the
student and parents before the student’s departure.
Club Secretary / YEO Name Signature District Chair Name Signature
Date (e.g., 01/Jan/2006) Home Phone E-mail Date (e.g., 01/Jan/2006) Home Phone E-mail