Inbound Standardized Forms

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These forms have been approved for use in the audit of ESSEX student.   These FORM should be used and maintained in this order for each ESSEX Inbound Student.   Records must be maintained for 3 years. 

Click the form number to download the form.

Audit #	Document	Form	Date	Notes
	ESSEX Inbound Student Index	IB99	Jan 2011
	Student Forms
1	Inbound Student Tracking	IB1	Jan 2011	For District/Club YEO to track MONTHLY contact with the student.   Of note, each visit needs explanation of visit and corrective action, if necessary.
2	Copy & Insert Inbound Documents: 1.  Completed Guarantee Form 2.  Student Application with all            signatures and attachments 3.  Airline itinerary 4.  Insurance Coverage 5.  *  DS-2019 6.  *  I-94 Card 7.  *  Passport 8.  *  Visa *retrieve these forms by or at orientation	IB5	Feb 2011	District - make copies of these documents for the student file
3	INB Dist Chair App Checklist	IB9	Jan 2011	District - keep copy with the student file (comes with the application from the Country Contact)
4	INB Club Chair App Checklist	IB13	Jan 2011	District - keep copy with the student file (comes with the application from the Country Contact)
5	INB Electronic Hosting - TYPE	IB21	Jan 2011	Club YEO should send copy to District Chair - TYPED
6	School Admission Letter & Explanation	IB25	Feb 2011	School letter with explanation of letter should be processed with the Guarantee Form
7	School Checklist	IB29	Jan 2011	MUST secure this form with signatures of School Official at the same time you process the guarantee form.
8	Inbound Welcome/Info Letter	IB33	July 2011	Student must receive prior to arrival; must document (copy of letter in student file) and the following forms should accompany the letter:  IB41, YE325, DOS, SX725, SX715, IB37, IB45
9	Inbound Rules	IB41	Feb 2011	District should receive signed copies prior to arrival (accompany info ltr) and must be documented
10	Independent Travel	YE325	Feb 2011	District should receive signed copies prior to arrival (accompany info ltr) and must be documented
11   12	DOS Welcome Letter   The Exchange Visitor Program	DOS   SX725	March 2013   Sept 2011	Each Inbound student must received DOS welcome letter and Visitor Program prior to arrival and must be documented
13	Essex Student Protection Brochure	SX715	Jan 2011	Student must received prior to arrival and must be documented
14	Resource List	IB37	Jan 2011	Fill in the appropriate information for your local area and send to the student prior to arrival, document receipt
15	Receipt of Documents	IB45	Jan 2011	Student and natural parents must sign and return to the District, receipt that they received the required documents mentioned above.
16	Student Orientation Record	YE329	Jan 2011	Signed confirmation of student orientation
17	ID Card   ID Templete - Publisher doc  developed - Aug 2011 ID Templete - Word developed - June 2012	YE333	June 2012	Every student must receive an ID card for every host family, District must supply to student
18	Monthly Report	YE305	Aug 2012	Every student must complete monthly report, email reports are acceptable, document in student file with copy of email or report
19	Training Roster	YE301	Feb 2011	To be used for all training sessions to document attendance
20	Host Family change Form	IB50	Jan 2011	Club Chair and/or student should report to the District any host family change with 5 days of placement.  VERY IMPORTANT:    District Chair MUST report to ESSEX IB Coordinator any change to host family with 5 days.  This is a DOS requirement that is being monitored.
21	Post Evaluation - Student	YE313	Jan 2011	Every student must complete prior to departure
22	Post Evaluation - School	IB49	Feb 2011	School official must complete at end of the school year or if the student is an early return immediately upon departure of the student.
23	Incident-Complaint Report	YE309	Aug 2012	A District Chair should use this form when there is a need to report a complaint or incident.   The District Chair must send copies promptly to ESSEX Youth Protection Office, ESSEX Chair, RI Youth Exchange Dept  and the DOS, if reporting on IB.    Reporting should be done immediately upon knowledge of issue.

 

	VOLUNTEER  FORMS Non- host family
24	Volunteer Application	YE320	April 2011	One per volunteer, non host family  Retain at the District
25	Volunteer Reference Form	YE318	Jan 2011	Two references per volunteer;   References can not Be a relative and one 1 Rotarian reference is allowed Retain at the District
26	Student Protection Waiver	YE321	Oct 2012	Every volunteer 18+ of age must complete waiver for background  check EVERY YEAR - DO NOT SAVE A COPY - CONFIDENTIAL - ORIGINAL TO CBC to process   Must document and file for audit Counselor/YEO email confirmation of clearance.