Outbound Student Arrival Report Form

To: Youth Exchange District 9455 Chairman

IMPORTANT: This Form MUST be completed within two weeks of your arrival in your host country. Complete the Form with ALL possible details that are known to you. In particular you need to confirm the name and address of your first host family and your host mentor’s details if you have them.To submit the Form, simply fill in the details to the best of your knowledge and click the “Submit” button. The Form will be e-mailed to the District 9455 Youth Exchange Chairman.

Arrival Form

Student Name*
First Last
Student Email*
Student Mobile Phone Number*
Date of Arrival*
Sponsor Rotary Club in Australia*
Details of First Host Family
Host Family Name
Host Family Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Host Family Telephone Number
Host Family Email
School to be Attended
Expected Class, Grade or Form at School
Student Interview with Prinipal on
Probable Number of Host Families During Exchange
Has Pocket Money (allowance) by Club been commenced?
- Yes
- No
How much money monthly?
Has Emergency Fund been banked in Joint Names of Student and Counsellor?
- Yes
- No
Details of Host Club Mentor
Host Rotary Club
Country of Exchange
Host Club District
Host Mentor's Name
First Last
Have you had any contact with your mentor before?
- Yes
- No
Host Mentor's Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Host Mentor's Phone Number
Host Mentor's Email
Were any difficulties experienced in your travel en-route or in being met on arrival?
After completing as many fields as you can, click on the “Submit” Button to e-mail this report to the District 9455 Chairman. You will be transferred immediately to a confirmation webpage if you have successfully sent your report.

Arrival Report Form- All Outbound students

Outbound Student Arrival Report Form

Arrival Form

Details of First Host Family

Details of Host Club Mentor