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These forms have been approved for use in the RI certification process.      These FORM should be used and maintained in this order for each ESSEX Outbound Student.     Records must be maintained for 3 years.   

To download a form please CLICK the Form Number.

 OUTBOUND DOCUMENTS

Document	Form	Date	Notes
ESSEX Outbound Student Index	OB599	02/15/09
Outbound Student Tracking	OB501	02/15/09	For District/Club YEO to track student contact
Insert Outbound Documents	OB505	02/15/09	District - have copies of these documents in student file
Outbound Rules	OB509	02/15/09	signed copy per student prior to departure
Independent Travel	YE325	11/10/09	signed copy per student prior to departure
Outbound Checklist	OB513	02/15/09	District - one per OB
Outbound Withdrawal/Early Return	OB517	02/15/09	If students terminates or ends exchange prior to June 1st of exchange year
Student Orientation Record	YE329	02/15/09	Signed copy per student
ID Card	YE333	02/15/09	each OB should received 4-5 ID cards (keep copy)
Training Roster	YE301	02/15/09	for use with any training session, ie YEO, counselors, students, etc
Outbound Hosting	OB521	02/15/09	form will be returned with Guarantee Form
Host District Verification	OB525	02/15/09	for foreign Club or District YEO to confirm
Monthly Report	YE305	02/15/09	student must submit rpt for each month of their exchange
Post Evaluation - Parent	OB529	02/15/09	parents must submit at conclusion of exchange
Post Evaluation - Student	YE313	02/15/09	student must submit at conclusion of exchange
Incident-Complaint Report	YE309	02/15/09	For pertinent incident/complaint that OB students reports during exchange year

INBOUND DOCUMENTS

Document	Form	Date	Notes
Inbound Student Index	IB99	08/14/09	Printable list of forms below
Student Forms
** Inbound Student Tracking	IB1	02/15/09	For District/Club YEO to track student contact throughout the year
** Copy & Insert Inbound Documents	IB5	08/14/09	District - make copies of these documents for the student file
** INB Dist Chair App Checklist	IB9	02/15/09	District - keep copy with the student file (comes with the application from the Country Contact)
** INB Club Chair App Checklist	IB13	02/15/09	District - keep copy with the student file (comes with the application from the Country Contact)
** INB Electronic Hosting	IB21	02/15/09	Club YEO should send copy to District Chair
** School Admission Letter	IB25	02/15/09	School letter should accompany the Guarantee Form
** School Checklist	IB29	02/15/09	Confirmation that school received information
** Inbound Info Letter	IB33	02/15/09	Student must receive prior to arrival; must document
** Resource List	IB37	02/15/09	District should complete with at least the local resources and send to student prior to arrival (accompany Info ltr)
** Inbound Rules	IB41	10/30/09	District should receive signed copies prior to arrival (accompany info ltr)
** Independent Travel	YE325	11/11/09	District should receive signed copies prior to arrival (accompany info ltr)
** Student Receipt	IB45	02/15/09	Signed copies returned prior to arrival
** Student Orientation Record	YE329	08/12/09	Signed confirmation of student orientation
Section One:  Topics to Discuss
CISI Bolduc Information/ 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
Travel Arrangements, Permission, and Requirements - For Outbound Student Only
DOS Welcome Letter DOS Toll Free Number Flyer
Discuss and Distribute the following:           -   Exchange Visitor Program Brochure (SX725)           -   ESSEX program brochure/ Contact Carl Hill           -   ESSEX Student Protection Policy (SX713)           -   ESSEX - Allegation Reporting Gudelines (SX714)           -   ESSEX Student Protection Brochure (SX715)           -   ESSEX Reporting Flow Chair (SX716)			-   First night questions               to view questions in other lanagues go to               www.rotary.org (search for first night questions)           -   Student Monthly report form (YE305)           -   Student Post Exchange Evaluation (YE313)           -   Metric conversion                      www.worldwidemetric.com/metcal.htm           -   ID Cards (YE333)
** ID Card	YE333	02/15/09	Student receives ID card per host family (keep copy)
** Training Roster	YE301	02/15/09	for use with any training session, ie YEO, counselors, etc
** Student Monthly Report	YE305	02/15/09	student must submit report for each month of their exchange
** Incident-Complaint Report	YE309	02/15/09	for pertinent incidents or complaints that IB students report during their exchange year:   send copies as noted on form
** Post Eval - 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 DOCUMENTS

Document	Form	Date	Notes
ESSEX Host Family Index	IB299	08/14/09	Printable list of forms below
Host Family Forms
**  Host Family Tracking Form	HF201	02/15/09	Club YEO to track host family visits, one per family
**  Host Family Application	HF205	08/14/09	One per family, to be completed at time of initial interview
**  Student Protection Policy Appendix A   "Personal Information"	YE317	11/11/09	Each family members 18+ of age must complete
** Student Abuse Waiver	YE321	02/15/09	Each family member 18+ of age must complete waiver for background check
**  Host Reference Form	HF209	11/11/09	Must check, at least, two references per background check
**  Host Family Interview Form	HF213	11/11/09	Club YEO to confirm Host Family in-home interview
**  Host Family Orientation	HF217	02/15/09	District or Club to confirm that the Host Family attended an Orientation
Section One:  Topics to Discuss			Click Here to view "Host Family Training"  Power point presentation / you can adapt to your District or Club
Supply the family with resource book or booklet on Host Family Survival			Suggestions are : - RI "Primer for Host Families" download or purchase booklet from http://www.rotary.org/RIdocuments/en_pdf/749en.pdf - Host Family Survival Kit Book; Intercultural Press:     617-523-3801
CISI-Bolduc Information                                       Insurance coverage and claim procedures			http://www.culturalinsurance.com/rotary/rotary_medical_forms.asp
ESSEX program brochure/ Contact Carl Hill for supply ESSEX Rules and Guidelines ESSEX Independent Travel Guidelines			Click the document to view
First Night Questions			Click the document to view -    to translate questions in other languages go to www.rotary.org (search for 1st night questions)
Culture Shock/Intercultural Communications/Cross Cultural Interactions			Click the document to view:  other similar documents on Culture Differences can be viewed on:  www.yeoresources.org
ESSEX Student Protection Policy ESSEX Student Protection Brochure			Click the document to view
DOS Welcome Letter  DOS Toll Free Number Flyer DOS Welcome Brochure			Click the document to view
** Training Roster	YE301	02/15/09	For use with group training sessions, ie Club, YEO, counselors
** Unforeseen Host Family Change	HF221	02/15/09	To document unforeseen changes of host family
** Post Host Family evaluation	HF225	02/15/09	One for each host family