Short-Term Exchange Application
>> Download the Application >>

Before You Begin

Please contact your local Rotary club BEFORE completing this application. Some clubs
have additional application forms and/or rules. If you live in the areas that are members
of the Rotary ESSEX organization, you may call our toll free number and leave a message.
The number is 1-888-ROTARYX. Your message will be forwarded to your local Rotary
club and you will be contacted shortly.

See the ESSEX Map for the areas of the USA and Canada that are part of ESSEX.

Please read through the Short Term Handbook. It will answer many of your questions and save you a great deal of time.

http://www.exchangestudent.org/literature/Rotary Short-Term Exchange Handbook.pdf

Short Term Application Download

Note: This is a writable .pdf. This file can be downloaded to your desktop, completed, and printed using the free version of Adobe Acrobat Reader. If you do not already have Adobe Acrobat, download it FREE here.

Download the Application: http://www.rotary.org/newsroom/downloadcenter/pdfs/763en_write.pdf

Download the Application

Download the short-term exchange application used by most Rotary districts in ESSEX
by clicking on the link at the top or bottom of this page. This application allows you
to complete and print many parts of the application with your computer. Other parts,
like recommendation forms and medical forms, must be completed manually. The
application should then be sent by mail with photographs and other required documents.


Fill Out the Application

Download the application form by clicking on the “Download the Application” link at
the top or bottom of this page. The form will automatically download the pdf file
(763en_write.pdf) to your desktop.

Open the application form, named 763en_write.pdf, using
Adobe Acrobat Reader. Upon selecting a location on the form, an "insert" cursor will
appear on any data line that can be filled in using the computer. The cursor will
appear as a "hand" for locations that are not available for data entry. It is possible
to use the "tab" key to step through the form (except for check boxes) as a simple
way to fill out the form.

Type in the requested information, including the name, address and phone number
of your local Rotary Club chairman and your district chairman. E-mail addresses are
greatly appreciated. ALL applications should be typed. It is easier to read and faxes
better. Scanning pictures onto the first and last pages works well.

PLEASE NOTE: You cannot save parts of the application that you have filled in on
your computer. You must print the pages that you have completed before you quit
out of the file or you will lose the work you have done on them. If you find a mistake
on a page and have already exited the form, you will have to retype and reprint that page.

Additionally, the application does not print out well on some ink jet printers. We
recommend that you fill out and print the application on a laser printer, if possible.

Print at least 6 copies. You are required to submit a minimum of 4 copies of the
application, but your Rotary district may require more. All copies must have original
color photos and original signatures. You and your parents should sign all copies with blue ink.

You have already completed your country choices on the application, but it is very,
very important that you communicate to your club chairman and/or your district chairman
how flexible you are. For example, If you are willing to go to any Spanish–speaking
country, make sure your chairman advises us on your application checklist. If you will
only go to your first choice or if there is somewhere you won’t go, let us know. Sometimes
we are unable to get cooperation from the foreign contacts. When this happens having
several options helps find you a suitable match.


Deliver the Application

Keep one copy of the application for your files. Mail or deliver your application to the
local Rotary club. The local Rotary club will interview you before referring your application
to the district. If you are accepted for the program, the Rotary District Short-Term Chair
or Youth Exchange Chair will sign your application before it is sent onto ESSEX and a
Rotary club in the host country.


Apply for Medical Insurance

All students are required to carry the ESSEX-sanctioned medical insurance. To enroll online by credit card, please click here: webapps.aifs.com/RotaryOnline/. To download an application and submit by mail or fax, please click here: www.cisi-bolduc.com/rotary_app.htm. As a minimum, you MUST take the 3-month, short-term Plan B.


Pay Associated Fees

At some point, you will need two or three checks with your application to the club or
after your application is accepted by the district:

• One made out to “ESSEX STEP” for the amount of $65.00.
• One made out to CISI-Bolduc for the amount of the insurance policy.
• One made out to your Rotary district if there is a district fee.


Apply for Your Passport

Apply for your passport if you don’t already have one. Be sure to allow enough time
for it to be processed.


>> Download the Application >>

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