These forms have been approved for use in the audit of student materials.   Forms below identified with "A" should be used and maintained in this order for each ESSEX Inbound Student.    Records must be maintained for 3 years. 

To download a form please CLICK the form number.  

Download the Inbound  "BLUE BOOK" 2010-2011" (update 7/28/2010) - necessary documents to meet the audit process.

Document		Form in Adobe		Form in Word	Date	Notes
		Adobe		Word
ESSEX Inbound Student Index		IB99			07/25/10
"A" audit documents
Student Forms
Inbound Student Tracking		IB1- "A"			07/25/10	For District/Club YEO to track student contact throughout the year
Copy & Insert Inbound Documents		IB5- "A"			07/25/10	District - make copies of these documents for the student file
INB Dist Chair App Checklist		IB9			12/06/09	District - keep copy with the student file (comes with the application from the Country Contact)
INB Club Chair App Checklist		IB13			12/06/09	District - keep copy with the student file (comes with the application from the Country Contact)
INB Electronic Hosting		IB21		IB21	12/06/09	Club YEO should send copy to District Chair
School Letter Explanation School Admission Letter		IB25A IB25- "A"			12/06/09 12/06/09	School letter should accompany the Guarantee Form
School Checklist		IB29- "A"			02/15/09	Confirmation that school received information
Inbound Info Letter		IB33- "A"		IB33- "A"	07/25/10	Student must receive prior to arrival; must document
Inbound Rules		IB41- "A"			10/29/09	District should receive signed copies prior to arrival (accompany info ltr)
Independent Travel		YE325- "A"			10/23/09	District should receive signed copies prior to arrival (accompany info ltr)
Student Receipt		IB45- "A"		IB45- "A"	02/15/09	Signed copies returned prior to arrival
Resource List     Dept of State Letter to Student 4/2010		IB37- "A"       DOS -"A"		IB37- "A"	07/25/10       4/2010	District should complete with  the local resources and send to student prior to arrival (accompany Info ltr)   Each Inbound student must received DOS welcome letter
Student Orientation Record		YE329- "A"			07/12/09	Signed confirmation of student orientation
CISI Bolduc Information -Inbound students are required to purchase Health and Liability insurance - Plan B - To purchase insurance online					https://webapps.aifs.com/RotaryOnline/Agreement.aspx?agree=N
CISI Bolduc Information -Insurance coverage and claim procedures					http://www.culturalinsurance.com/rotary/rotary_medical_forms.asp
DOS Welcome Letter April 2010  - "A" DOS Toll Free Number for Students					1-866-383-9090
ID Card	YE333-"A"		YE333- "A"		07/25/10	Student receives ID card per host family (keep copy)
Monthly Report	YE305-"A"		YE305- "A"		07/25/10	student must submit report for each month of their exchange
Training Roster	YE301-"A"				07/25/10	for use with training session, ie YEO, counselors, IB Student, OB students, OB parents, etc
Post Evaluation - Student	YE313				02/15/09	student must complete at end of exchange, prior to departure
Post Evaluation - School	IB49				02/15/09	school representative to complete at the end of the school year
Host Family Change Form	IB50		IB50		12/9/09	Host Family Changes MUST be reported to ESSEX INBOUND COORDINATOR with 5 days of change
Incident-Complaint Report	YE309		YE309		02/15/09	for pertinent incidents or complaints that IB students report during their exchange year:   send copies as noted on form
Allegations Reporting Guidelines ESSEX Student Protection Policy Brochure	SX716   SX715-"A"				2/15/09   2/15/09	For Resources to the Club and District Each Student should receive copy of this Policy

MISC FORMS /VOLUNTEER	Form in Abode	Form in Word
Student Protection Policy Appendex A "Personal Information"	YE317- "A"	YE317- "A"	07/25/10	One per volunteer
Volunteer Reference Form	YE318- "A"	YE318- "A"	07/25/10	Two references per volunteer
Student Protection Waiver	YE321- "A"		07/25/10	Each volunteer 18+ of age must complete waiver for background check - If Rotarian once every 5 years, if not Rotarian every year DO NOT SAVE A COPY - CONFIDENTIAL - ORIGINAL TO CBC to process