Rotary D5010 Youth Exchange

Host Family Application

The Rotary Youth Exchange Program appreciates your interest in hosting an exchange student, and we are confident that this will be a truly rewarding experience for you.

The US State Department issues Visas for our Inbound Students. Although marijuana use is legal in the State of Alaska, Federal Regulations prohibit marijuana use unless prescribed by a doctor.  Therefore, families who use marijuana are ineligible to apply.

The US State Department requires that we obtain the information on this form and conduct background checks on all potential host families. We assure you that the information that we receive will be treated confidentially and we thank you for your assistance and understanding.

Remember to SUBMIT the application when complete.
There are 9 sections. You can do it all at once or in parts, saving each part as you proceed to the next one. You can go back and change previous pages that have been saved.
Here is the information you will need to provide:
Section 1: personal information on each parent - name, contact information, background and profession.
Section 2: information about children in the family and anyone else living in the home. The system relies on separate email addresses for all those 18 and over for the required Background Checks and Youth Protection Awareness training. It also asks about family interests and languages spoken in the home.
Section 3: information about the home, including the address, a general description, the student's room and pets.
Section 4: questions about the school the student will attend and the community.
Section 5: family preferences on gender of student, dietary restrictions, religious practice, expectations for student responsibilities and behavior.
Section 6: asks a variety of general questions.
Section 7: names and contact information for two references. Note that relatives may not be used as references and only one reference can be a Rotarian.
Section 8: photos of the home and family that you take and upload. Photos of the home include the exterior, living room, kitchen, student bedroom, and bathroom.
Section 9: the final section is the consent and agreement and electronic signatures.
All sections must be completed and the application signed electronically before it can be submitted.
Feel free to contact us or your local Youth Exchange Officer for additional information.
Thanks for your interest in Rotary Youth Exchange.