Two Rivers Rotary Club 2764

Rotary Youth Profile Form
Rotary Exchange- Inbound
Rotary Exchange- Outbound
Interact or Jr. Rotarian of Month
Country Country Interact -YesNo
Exchange Dates (From/To) Exchange Dates (From/To) Month/Yr at Rotary
Host Families/Dates
Host Families/Dates
Interact Club Offices Held









Full Name
Phone
Email
Tell us about your childhood.
When and where you were born, siblings, parents, special people in your life, etc.
Tell us about your extra curricular activities (band, clubs, sports, lessons, music, etc and positions/leads played, any awards or recognitions)
Tell us about your schooling (current grade level, grades, classes, awards, honors, best/worst classes etc.). What are your future school plans?
Tell. us about you and/or your family work history and where you have lived.

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Tell us about your hobbies or interests.
Tell us about your organization affiliations (not covered above). Now or past. List offices held. Why did you want to be a Rotary Exchange Student, Interact Member or Jr. Rotarian of the Month? How did you learn of the program?
Any other information including change of address, phone, email, status, or anything else you are willing to share (best friend, best TV show, best/worst teacher/class/job, permanent home address, etc.)
New Information
Updated Information
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Archives Youth Profile Form
Two Rivers Rotary Club P.O. Box 272 Two Rivers WI 54241-0272


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