To YEO's, Club Counselors and Rotary Youth Exchange Weekend Organizers:

On behalf of the District 5000 Youth Exchange Committee, I am attaching a new form that has been developed for you to use in the following circumstances.
By using this form, we are trying to have a reasoned balance between the extremely strict Department of State requirements for Inbound student safety and well-being and the natural flow of activities that should occur during the students year in this country. Inbound students and their parents sign a separate form wherein the student agrees not to engage in illegal, harmful or potentially dangerous activities. If the student violates any of these restrictions, he or she will be sent home.
So it is important that those individuals who are hosting or accompanying these students be aware of these restrictions. It is also important that the Host family and club YEO or Counselor know who these individuals are and feel comfortable with entrusting the student's safety to them because they are in effect acting as the student's parents.
Special Activity Form Instructions
This form is to be used in lieu of a full criminal background check for adults who will have short-term contact with a Rotary Youth Exchange Student such as…
  • Hosts for Youth Exchange Weekends
  • Drivers who transport a youth exchange student to Youth Exchange weekends, school activities, shopping excursions or other events
  • Host parents for sleepovers where a child in the family has invited the exchange student
  • Adults who invite an exchange student to join them or their family for a one-day trip to a special destination such as a local festival, movie, show, Honolulu, island different from home island, etc.)
  • Any adult who may have unaccompanied, one-on-one contact with the exchange student
The form is meant to be both date specific and date general. That is if there is a unique occasion, then a single date should be put in. If the individual will be accompanying the student over an extended period of time, then a range of dates should be put in. Again, we're trying to balance security and reasonableness.
The full Background check is still required for Host Family members 18+, Youth Exchange Officers and club Youth Exchange Committee members. Please let us know if you have any questions.