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Club transmittal check list

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CLUB TRANSMITTAL CHECK LIST
RETURN WITH APPLICATION TO ROTARY DISTRICT 5440 OFFICE
Enclosed is the application of:
Sponsored by
Club ranking:
Rotary Club
of
applicants.
Club contact:
Address:
City:
Phone:
State:
Zip:
FAX
E-MAIL:
I have verified that all items on the attached “Outbound Applicant’s Check list” are
completed and enclosed.
In return for the District's acceptance of this student, our club agrees to host an inbound
student for the 2015-2016 school year (inbound student will arrive in either August 2015 or
January 2016 and attend one full school year).
Our Club Youth Exchange Officer has established an account in the Rotary YEAH (Youth
Exchange Administration Hub) system.
We agree to abide by Rotary Youth Exchange Rules and Regulations, including compliance
with CCYE Youth Protection Policy.
Signatures:
Club Y.E. Chairman
and
Rotary Club President

The application will not be accepted by the District Committee without proper signatures and
documentation.

Application materials are due October 31, 2014 to:
Kellie Tovar, Rotary District 5440
Cowboy Country Youth Exchange
3729 West 22nd Street
Greeley, CO 80634
970-506-1036 (phone/fax)
[email protected]
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