I'm Interested in an Exchange

Student Exchange Expression of Interest
Thank you for your interest in becoming part of a Rotary Australia - New Zealand Student Exchange.

This is a wonderful opportunity for the student to be away from home and be "independent" in a supervised environment.
Applicants Name*

First NameLast Name
Parent's Names*
Gender*

MaleFemale
Date of Birth*
E-mail*
Parent's Phone Number*

Area CodePhone Number
Parents Mobile Number

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityProvince

Post CodeCountry
Tell us about yourself

We'd love to learn why you decided to look into a Rotary Student Exchange. Please provide a brief profile of yourself to allow us to learn something about you. Details may include your sporting likes, where you were raised, educational and family background, your hobbies and more. As much or as little as you like.
Profile
Is your school happy for you to be involved in an exchange?*

YesI haven't asked yet
Any Questions or Comments for us?
How did you hear about RANZSE?*
Enter the message as it's shown*
By submitting this inquiry form, I consent to receive emails from Rotary. I understand that I can opt out at any time.
I Agree to the all the above*

Yes, I agree
Should be Empty:

Student Exchange Expression of Interest