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ROTARY D5360 LONG TERM YOUTH EXCHANGE PROGRAM

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					        ROTARY D5360 LONG TERM YOUTH EXCHANGE PROGRAM
                 CLUB CHECKLIST FOR RI CERTIFICATION
                               2009/2010 Rotary Year
(YEX=Youth Exchange; YP=Youth Protection; RI Cert= Rotary International
Certification; PSC = Police Security Clearance; IB = Inbound; OB= Outbound)

Club Name: ___________________________________________

On YEX5360.ORG

____ (1) Reviewed steps for club participation in YEX.
____ (2) Reviewed Youth Protection Information, policy, procedures and forms

CLUB YEX COUNSELLOR PREPARATION:
____ (3) All Inbound and Outbound Club Counsellors will have undergone PSC.
____ (4) All Inbound and Outbound Club Counsellors will have attended YEX
         Orientation Weekends and participated in role training sessions.

 HOST FAMILY PREPARATION: (Recommend 4 host families per IB student)
____ (6) Each Host family will have been interviewed
____ (5) Each Host family will have completed a volunteer information form.
____ (7) All adults in each household will have under gone PSC.
____ (8) All adults in each household will have received role training.
____ (9) A home visit will be conducted by the Club Inbound Counsellor
____ (10) An evaluation will be completed for each host family.

STUDENT SELECTION AND SCREENING:
____ (10) All student exchange candidates will complete a written application and
          be interviewed .
____ (11) Attend and participate in all district orientation and training sessions.
____ (12) All parents or legal guardians of student exchange candidates will be
          be interviewed.

CLUB COMPLIANCE:
____ (13) A contact list of community services will be provided for IB students.
____ (14) A contact list of club executive/ club YEX members plus one male and
           one female non-Rotarian will be provided for IB and OB students.
____ (15) All YEX club volunteers, Rotarian and Non-Rotarian, informally
           involved on a regular basis will have undergone PSC and Awareness
           Training.
_____ (16) Signing of the Club President’s declaration attesting to the commitment
          to complete the checklist requirements.
_____ (17) Sending the completed checklist and signed declaration to D5360 Rotary
          Youth Exchange Secretary, knowing that a copy will be kept on file with:
                            Ms. Susan Williams
                            Rotary District 5360Administrator
                            246 Stewart Green S.W.
                            Suite #2506
                            Calgary AB T3H 3C8


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             D5360 ROTARY INTERNATIONAL LONG TERM
                     YOUTH EXCHANGE PROGRAM

                    ROTARY CLUB CERTIFICATION

                          CLUB DECLARATION


D5360 LONG TERM YOUTH EXCHANGE PROGRAM CERTIFICATION BY ROTARY
INTERNATIONAL IS CONTINGENT ON EACH PARTICIPATING CLUB WITHIN THE DISTRICT
BEING CERTIFIED.




TO THE D5360 DISTRICT GOVENOR AND TO THE LONG TERM YOUTH EXCHANGE
COMMITTEE CHAIR:



I _________________________________, CLUB PRESIDENT FOR THE ROTARY CLUB OF

___________________________________, DECLARE THAT THE COMPLIANCES AS SET

OUT IN THE CHECKLIST OF REQUIREMENTS FOR RI CLUB CERTIFICATION FOR THE

2000/2010 D5360 YOUTH EXCHANGE PROGRAM WILL BE ACHIEVED.

DATE:______________________

CLUB : ________________________________________________________________

SIGNATURE OF CLUB PRESIDENT: ___________________________________________




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