Long-Term Exchange Program
Guarantee Form
Full Legal Name as it appears on passport or birth certificate (use all capital letters for your FAMILY name) Gender
M F
Home Address — Street City State/Prov. Postal Code Country
Postal Address (if different) — Street City State/Prov. Postal Code Country
Home Phone Mobile Phone E-mail
Date of Birth (e.g., 01/Jan/1999) Place of Birth (City, State/Province, Country) Citizen of (Country)
Sponsor Rotary District Host Rotary District Host Country Arrival Airport in Host Country