wales exchange application 2015 2

8/9/2019 Wales Exchange application 2015 2

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his application form must be completed and submitted to a member of the Norfolk-Welshpool (Welshpool) Committee by

ail, e-mail or fax on or before the deadline. By completin this application and submittin it before the stated deadline, you

ll be considered for a position as part of the current years exchane proram. Before applyin, please re"ie! all eliibility

#uirements and phone or e-mail any Welshpool Committee member for clarification, special circumstances or re#uests.

here !ill be a minimum of six positions plus t!o alternati"es selected. $n alternati"e !ill ha"e the option to participate in

e exchane in the e"ent a selected indi"idual resins or is remo"ed from the exchane.

igibility:

ust be&

et!een the aes of ' and ' - *ee next noteyears of ae at the time of tra"el in %arch

illin to host a student in +ctober (to recei"e reciprocal hostin in %arch)

illin to participate in desinated e"ents (otary meetins, trips, e"ents)

illin to act as ood!ill ambassadors !hile participatin in the exchane proram

olice Checks:

l people o"er the ae of ' in the household must complete the clubs "oluntary assessment form and ha"e a police

eck performed and submitted to the committees representati"e. olice checks are not maintained by the club but must

presented to either the elected official from the committee or the club counselor per the clubs by-la!s.

equired Information:

e re#uire the selected information to ensure that e"eryone in"ol"ed in the proram may be contacted. This

formation !ill be retained !ith the utmost confidence and pri"acy based on the clubs pri"acy policy.

osting:

ostin is mandatory for participation in this proram. 0t is preferred as the inbound student is expectin to host you

%arch. 1ou mus t als o be a"ail able to host the inb ound student i n your home. We reconi2e that there

ay be limitations in the family home !hich present challenes for hostin. 0f this exists, please tell us in the

plication and !e may ha"e alternati"e solutions.

articipation:rticipation and support of otary e"ents is an expectation and mandatory to participate in this exchane. This

mponent is in place to promote cohesion amonst roup members and to promote team!ork and comradely as !ell as

lp to raise funds to co"er the cost of the inbounds from Wales and some of the outbound costs associated !ith

rticipatin in this exchane. 3-4 a!areness5fundraisin e"ents !ill be desinated o"er the next '6 months to promote

d support the exchane in the community. 7ates !ill be set at least 6 months prior to allo! for chanes to !ork

hedules and family e"ents, failure to participate in one or more of these e"ents !ill result in your place in the exchane

in !ithdra!n and i"en to an alternate.

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eadline:ompleted Application Must be submitted by: May 29, 2015

ubmit To:

ease submit your complete application directly to a Welshpool Committee representati"e or Barbara Tanner-

llins, .+.Box 3', *imcoe, +N N31 48 orbarbtb9k!ic.com on or before May 29, 2015.

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NORFOLK-WELSHPOOL EXCHANGE APPLICATION FORM

www.facebook.com/WelshpoolRotaryouth!"chan#e
mailto:[email protected]://www.facebook.com/WelshpoolRotaryYouthExchangemailto:[email protected]://www.facebook.com/WelshpoolRotaryYouthExchange


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Required information:($n incomplete application may be excluded from this exchane proram. 0f a box does not apply to you, please complete the box !ith an N5$.

0f in doubt, please contact a committee member : see !ebsite for contact details).

Student Information:

;i"en Names (ast Name

$ddress&

City& ro"ince& ostal Code&

?-mail& /ihschool&

hone& Cell&

%edical Conditions (please attach additional paper if needed)& Birthdate ddmmyr= ae at time of tra"el in %arch

When applyin, please !rite a summary of at least 3@@ !ords, ( o n e p a e ) , as to !hy you !ould make a

ood candidate to represent your family, school, County and Country. 0n addition, please include a synopsis of

your family (adults and kids) !ith aes of kids, interests5hobbies, pets, and any special concerns you may ha"e, and

past tra"el experience. This !ill all help us best match you to a Welshpool student, if you are chosen to participate.

ote& $pplicants sinature confirms eliibility re#uirements and commitment to hostin and participation

expectations as noted abo"e.

$


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Applicant%s &i#nature:

'arent or #uardian si#nature andconsent for student to participate:

Parent(s) Information:

(ather:

;i"en Names >ast Name

%other&

;i"en Names >ast Name

(if the same as the students, complete as Asame as abo"e)

$ddress&

City& ro"ince& ostal Code&

?-mail&


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Please return this om!leted form "ith the attahed summary andsyno!sis diretly to a mem#er of the $elsh!ool %ommittee or &he'otary %lu# of orfol Sunrise.

*

wales exchange application 2015 2

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