Outbound Student Arrival Report – Rotary Youth Exchange, District 6220

Name*

First Last

Host Country*

Country

Student's Email*

Parent's Email (not your host parents)*

Host Parent Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Host Parent Email

Host Family Home Phone

Host Mother Cell Phone

Host Father Cell Phone

Email

This field is for validation purposes and should be left unchanged.