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 Name Last Name
Parent's Names *
Gender *

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

Area Code Phone Number
Parents Mobile Number

Area Code Phone Number

Address *

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? *

Yes I 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