Host a Youth Exchange Student Rotary Youth Exchange Host Family Application Thank you for your interest in welcoming a Youth Exchange student into your home. Tell us about your family below and a member of the District 5330 Youth Exchange committee will follow up. Hosting is a shared, supported experience — you are never on your own. * indicates a required field Your household First Name * Last Name * Co-applicant / partner name (optional) Email Address * Phone * Home Address * City * ZIP * Rotary Club (optional) If your family is connected to a Rotary club, let us know which. About your home & family Who lives in your home? * Please list everyone in the household — name, age, and relationship. Other adults (18+) regularly in the home (optional) Anyone 18+ who lives with or regularly stays in the home — needed for Rotary Youth Protection screening. Languages spoken at home (optional) Is your home smoking or non-smoking? * Non-smoking home Smoking home The student’s bedroom * Own bedroom Shared bedroom A student may share a bedroom with a host sibling of the same gender, but must have their own bed. Nearest high school & how the student would get there (optional) Your hosting plans How long are you able to host? (choose any that apply) A few months (2–4) About half the year The full year Flexible Time(s) of year you’re available (optional) Preferences or things a student should know (optional) Any preference on student gender, openness to any country/culture, and anything about your routine, faith, or diet. About your family Tell us about your family and why you’d like to host * Prior experience hosting students or teens (optional) Youth Protection & references Two personal references * Please provide two references — name and phone number for each. All adult members of our household agree to complete Rotary Youth Protection training and a criminal background check / fingerprinting. * We consent to a home visit and interview with the District 5330 Youth Exchange committee. * We have read and agree to follow the District 5330 host family guidelines. * Website Submit Application
