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: ___________________________________________
____ (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
____ (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
_____ (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.
Calgary AB T3H 3C8
21/10/2011 Page 1- 2
D5360 ROTARY INTERNATIONAL LONG TERM
YOUTH EXCHANGE PROGRAM
ROTARY CLUB CERTIFICATION
D5360 LONG TERM YOUTH EXCHANGE PROGRAM CERTIFICATION BY ROTARY
INTERNATIONAL IS CONTINGENT ON EACH PARTICIPATING CLUB WITHIN THE DISTRICT
TO THE D5360 DISTRICT GOVENOR AND TO THE LONG TERM YOUTH EXCHANGE
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.
CLUB : ________________________________________________________________
SIGNATURE OF CLUB PRESIDENT: ___________________________________________
21/10/2011 Page 2- 2