D) HOST CLUB AND DISTRICT GUARANTEE
The Rotary Club of Name of Club Club ID # District #
Club President Name Signature
Date (e.g., 01/Jan/2006) Home Phone
will provide room and board in approved homes, provide up to one year
of study at the secondary school level, invite the applicant to participate
in Rotary club and district events and activities typical of our country,
and provide guidance and supervision to assure the applicant’s welfare.
The host Rotary club will also give the applicant a monthly allowance in
the amount of US$ . District agrees to ensure adequate
training for host parents and Youth Exchange volunteers and orientation
for the student upon his/her arrival.
E-mail
Club Secretary / YEO Name Signature District Chair Name Signature
Date (e.g., 01/Jan/2006) Home Phone Date (e.g., 01/Jan/2006) Home Phone
E-mail E-mail
(E) HOST CLUB COUNSELOR (required)
(F) SCHOOLING GUARANTEE
Name of School Date School Starts
Address — Street
(To be completed by the school the applicant will attend in host
country) The applicant will attend school from date of school start for
one school year. Costs of tuition and activities not a part of the normal
curriculum must be paid by the applicant or his/her parents/guardians.
Affix School’s Stamp or Official Seal City State/Province
Postal Code Country
Phone Fax E-mail
Name of School Official Title/Position Signature Date (e.g., 01/Jan/2006)
(G) FIRST HOST FAMILY (required)
Student: Please submit this form with the rest of the completed application to your local Rotary club or district.
Your information will be shared with Rotary International. It will only be used for official RI business and not sold to or shared with third parties, unless
required by law to be released.
Rotary district/clubs: Please mail completed Guarantee Form to the address below.
Youth Exchange
Rotary International
One Rotary Center
1560 Sherman Avenue
Evanston, IL 60201-3698 USA
Name Address — Street
City State/Province Postal Code Country
Home Phone Mobile Phone Fax E-mai