短期交换英文申请书填写说明

1、短期交換英文申請書填寫說明前言：這份英文申請書將送至國外給你的接待地區，接待社與接待家庭，他們將依據申請書的內容來瞭解你，甚至因此決定是否接待你，為了讓他們對你有良好的第一印象申請書內容詳細、整潔是必要的，請詳讀所有注意事項後，仔細填寫以期跨出順利的第一步！A、 一般注意事項（General Instructions）1、 接待地區或接待社可因交換計劃的需要，要求申請者提供更詳細的基本資料（如殘障青年的交換計劃、新世代交換計劃）。2、 字體務必清晰易讀並以印刷體或電腦打字填寫，完整回答每一個問題，不可簡略（如：同上、或如第幾頁回答）。3、 每個答案必須寫在指定的位置，因此建議先寫一份草稿，確定

2、無誤後再重寫正式的申請書。 簽名（Signature）1、所有簽名必須保留原始筆跡（不可COPY）且請用藍色墨水。2、先填寫完整一份申請書，但簽名處保留空白，再COPY三份，然後相關人員分別在四份申請書上簽名。3、每份申請書上學生有二個簽名處，父母有一個簽名處。4、每個必要簽名的地方都有”符號。 5、第1頁保證書見證人（Witness）一欄請派遣社社長簽名。B、 特別指示事項（Specific Instructions）： 第一頁：1、地址（Address）：這必須是學生的通訊地址。2、父母或法定監護人（Applicant and Parents legal guardian）： 親生父母或法

3、定監護人資料務必完整，即使父母離婚，仍然必須徵詢未擁有監護權之一方同意，除非當事者被領養，或繼父母擁有監護權，其緊急連絡電話不可與公司或家裡電話相同，且確保能聯絡到父母本人，若有傳真或e-mail也請提供。3、日期（Date of Birth）：申請者生日請務必與護照所載相同，並以國際標準模式書寫，如：2003/Dec/214、電話或傳真（Telephone Numbers）：電話或傳真必須包括：國碼、區域號碼如：886-2-237033225、扶輪社與地區背書（Rotary Club and District Endorsement）：申請書填寫完成一式四份，請扶輪社秘書、社長簽名後送至地區

4、請地區青少年交換委員會主委簽名。國際扶輪第3480地區 Rotary International District 34804F, No. 67 Pao-Chin Rd., Taipei, TaiwanTel：886-2-23703322 Fax：886-2-23707776E-mail：r3480yepChairperson：PP Water Chen （Hsiu-Chin Chen） 第二頁：一、計劃規則與交換條款（Program Rules Conditions of Change）：1、申請者與親生父母，必須詳讀並遵守相關規範與條款，以避免因觸法而 在交換期間被提早遣回。2、所有簽名必

5、須是原筆跡且在扶輪社代表的見証下完成。3、接待地區可依其須要增減或修改本申請書所述之規章條款並適時告知申請者。二、醫療許可與讓渡（Permission for Medical Care and Release of Liability）：1、申請者與親生父母或法定監護人簽名同意，接待家庭、接待社在緊急情況代替申請者之親生父母或法定監護人決定接受必要之醫療照顧，並承擔一切相關費用。2、緊急聯絡人必須是申請者之家庭成員或其父母之親信友人，必要時能夠代替申請者之父母或法定監護人決定申請者相關必要之醫療處置。n 第三四頁：一、補充資料（Supplemental Information）：1、請完成接待

6、社與接待地區之通訊資料2、申請者若有飲食禁忌，請明列並闡述其原因；如：基於宗教、各人喜惡或醫療因素。3、詳盡的回答每一個問題，但答案以不超過二頁為原則，請表現申請者的特質與思想，因為這是申請者與接待社以及接待家庭溝通的開始。4、注意回答問題的言詞，不宜太粗俗也不必過於艱澀，文法與拼字講求正確文章條理分明，以期給對方良好的第一印象。 5、申請者若有抽煙或喝酒的習慣，甚至曾介入違禁藥品請誠實表明，此舉並不表示你一定會被拒絕，而是要慎重選擇你的接待家庭。 6、請參考”Supplemental Information中英對照”將讓你更精確回答問題。 第五頁：一、照片（Picture Page）： 1、

7、照片必需用雙面膠或膠水粘貼，禁用釘書針。2、照片可使用彩色COPY或原版沖洗四份，切勿使用糢糊或淩亂的照片，那將表示申請者準備不夠充裕。3、My Family 部份請選擇包含家庭成員的照片。Special Interest 部份請用申請者從事其所喜愛之嗜好或活動之照片。Something Important to me 部份秀出申請者的寵物、好友.。 4、必要時可在照片下方做文字說明。短期交換 Supplemental Information 中英對照此份資料為接待地區、接待社、接待家庭對你的第一印象及評價，也是決定是否接侍你的關鍵報告，請務必好好填寫！1. Please list the l

8、anguages you have studied and indicate your level of fluency.(1 = Poor, 2 = Marginal, 3 = Short Sentences, 4 = Fluent)請列出你會的語言並註明說寫流暢的程度1st Language 1 2 3 42nd Language 1 2 3 43rd Language 1 2 3 42. What is your favorite school subject? Why? 在學校你最喜歡的學科是什麼？為什麼？3. What are your interests and activitie

9、s? What leadership positions have you held (in school and outside activities such as scouting)? 你在學校對什麼感興趣？曾投入什麼活動？你曾經擔任什麼領導職位？ （在學校或校外活動像是童子軍）4. What are your hobbies and accomplishments? Elaborate on your interests in these areas (e.g., Why did you become interested in the activity? How long have

10、you been interested? How much time do you devote to the activity?).你有什麼嗜好和才藝？盡量敘述你興趣的範圍（例如為什麼你對這項活動有興趣？喜歡它多久了？花多少時間在你的興趣上？）5. What are your future plans and ambitions? 你未來的計劃和抱負是什麼？6. Why do you wish to participate in this program? 你為什麼希望參加此項計劃（青少年交換）？7. Most Rotary Clubs/Districts require you to ho

11、st the student with whom you will be staying while on this program. Is your family willing to host an inbound exchange student in your home? Yes No你的家庭願意接待外國交換學生嗎？What do you prefer as the gender of the student you will host? (Please check one) 對於你所要接待的外國交換學生有行性別上的限制嗎？請勾選你所喜愛者 Male Female Either8. D

12、escribe your community and home. 請描述你的社區與住家。9. Describe your family interests, activities, pets, siblings at home, etc. 請描述你的家庭休閒活動、嗜好、寵物與家中的兄弟姊妹。10. Identify four major issues confronting youth today. Select the most major issue and tell us why it is of personal concern. 列出你認為4件主要讓現代年青人感到衝擊及震憾的事件。選

13、擇最主要事件告訴我們你個人的感想。11. Medical Information 醫藥訊息a. Do you have any medical conditions? Please describe. 你現在有任何相關醫藥情況嗎？請詳述。b. Have you taken any prescribed medications in the prior six months? Please provide the name of the medication and reason it was prescribed. 你在最近6個月內有使用任何藥物嗎？請提供藥品的名稱和使用的原因。c. Do y

14、ou have any special health considerations (allergies, disabilities, etc.)? Please describe. 你有任何需要特別注意的健康問題嗎？（過敏症、殘障等）12. * Do you smoke? Yes No你抽煙嗎？ * Have you ever been involved with illegal drugs? Yes No你曾持有或使用違禁藥品嗎？* Do you drink alcoholic beverages? Yes No 你喝酒嗎 ？* If you answered “YES” to any o

15、f the questions asterisked, please explain: (see Instructions, inside cover page)假如你的答案是”是”，請說明（請參閱第一頁之指導說明）。Application for a Rotary Youth ExchangeShort Term ProgramSubmit completed application to:Read instructions on next page before completing applicationNote: Additional information may be requir

16、ed for specialized short term exchangesInstructions for Rotary Youth Exchange Short Term Program ApplicationRead these directions carefully before completing the application. If you are accepted as an exchange student, thisapplication will be sent to your host country. It will serve as your introduc

17、tion to the people who are being asked to host you. It is important that the first impression you make be a good impression. Complete this application carefully. All grammar and spelling should be correct. And remember, neatness counts.GENERAL INSTRUCTIONS:This application provides hosting Rotary Cl

18、ubs and Districts basic information from which short term youth exchangeplacements can be made. Hosting Rotary Clubs and Districts may add additional pages to obtain information applicablefor specialized short term exchanges (such as camps for students with disabilities, tours, New Generations Excha

19、nges,etc.). Applications must be legible. Typed or computer generated applications are preferred. Answer all questions asasked. Do not write “same” or “see page,” etc. Type answers on the application except where otherwise indicated.Practice on a draft copy of the application to make sure your answe

20、rs fit in the space provided.Signatures: All signatures must be originals and written in BLUE ink on all four copies. To accomplish this, complete one full application but do not sign it. Make three copies and then sign all four completed applications. The students signature is required 2 times and

21、parents signatures are required once on each copy of the application. To help you findsignature locations, all signature locations have been placed in boxes and asterisked (*).SPECIFIC INSTRUCTIONS:Page 1: Address This should be the students postal address.Applicant and Parents/Legal Guardian All pa

22、rental information must be completed. If your parents are divorced,provide the requested information for the non-custodial parent, not your step-parent unless he/she has legal guardianshipof you or has formally adopted you. If someone other than a parent is your legal guardian, provide the requested

23、information for the legal guardian. Authorizations must be obtained from all parents/guardians. Emergency telephonenumbers must be different than the home and business phone numbers. If your parents have a fax number or e-mailaddress, type it in the space provided.Date of Birth Remember to use the a

24、lphabetic abbreviation for month, e.g., (1986/Feb/22); not the numeric. Please note that this annotation of date of birth is the International Standard and may be different from what you are used to.Rotary Club and District Endorsement This will be completed by your Rotary Club and District Youth Ex

25、changeCommittee. Give all 4 copies to your Rotary contact for signature. In some cases, the school arranges for this. Check withyour guidance counselor. The District Endorsement will be completed if and when you are selected. Clubs and DistrictsPlease note that you also need to complete the top part

26、 of the Supplemental Section.Page 2: Program Rules and Conditions of ExchangeParents and students should read these carefully. You are expected to abide by these rules and conditions of exchangewhile a participant in the Rotary Youth Exchange program. Failure to do so may result in the termination o

27、f your exchange and early return home. All signatures must be originals. This should be signed in the presence of a Rotary Clubrepresentative. Note: These are rules and conditions jointly agreed to by most Rotary Districts. However, your HostingDistrict may add, modify or delete some of these rules

28、and/or conditions. You will be informed by your Hosting District of any changes.Permission for Medical Care and Release of Liability Read carefully. If you are ill and require medical care, this givespermission for your host family and/or a hosting Rotarian to act for your parents or guardians. This

29、 holds your naturalparents responsible for additional medical bills and transportation costs not covered by your insurance if required byyour illness. You and BOTH parents or guardians must sign where indicated. If your parents are divorced, you must getthe signature of the non-custodial parent unle

30、ss someone else has legal guardianship of you. Authorizations must beobtained from all parents and guardians.Emergency Contact Provide the name and telephone/fax of a family member or close friend of your parents who maybe contacted in case of an emergency if we cannot contact your parents. This sho

31、uld be someone who your parents trustto make decisions about your medical care when your parents are not available.Pages 3-4: Supplemental Information (Sponsoring Club and District must complete the top part of this page)Answer each question succinctly. Give thought to the message you are communicat

32、ing to your future host club andfamily. You may add up to two typed pages if needed. If you have dietary restrictions, be sure to state clearly what youwill not eat. If you smoke, drink alcoholic beverages or have a past or current involvement with illegal drugs, be sure toprovide the explanatory in

33、formation requested. A “yes” answer will not automatically eliminate you, however, it willnecessitate special consideration by the host family.Page 5: Picture page Affix the pictures to the page with glue or double-sided tape (do not staple). You may either makecolor copies of the page or use all or

34、iginal copies of the pictures.Smile!Attach a good quality,color head-and-shoulderrecent photograph2 in. x 2.5 in.(5 cm. x 6.5 cm.)Application for aRotary Youth ExchangeDistrict Long Term ProgramType the application, make three copies and SING each application in BLUE ink. All signatures must be orig

35、inals. All dates are yr/mo/day. Read the Instructions first.Applicant Family name/Legal name First/Given name Want to be called Sex (M/F) Street Address City State/Province Country of Residence Postal Code Date of Birth (yr/mo/day) City of Birth State/Province of Birth Country of Birth Citizen of (C

36、ountry) Home Telephone E-mail AddressI, as the above applicant, hereby state that I am of good health and character, understand the importance of the role of a youth ambassador as a Rotary Youth Exchange Student, have read and agree to abide by the Program Rules and Conditions of Exchange detailed o

37、n page 2 of this application and will, to the best of my ability, maintain the high standards required of a Rotary Youth Exchange Student should I be chosen to represent my sponsoring Rotary club and district, my school, community, state/province and country as an exchange student. I further state t

38、hat all the material contained in this application and documents attached hereto are true and accurate to the best of my knowledge. Applicants Signature Date (yr/mo/day)Parents/Legal Guardians Natural Fathers Name/LegalGuardian Natural Mothers Name/Legal Guardian Address Address Occupation Business

39、Telephone Occupation Business Telephone Home Telephone Emergency Telephone Home Telephone Emergency Telephone Fax E-mail Fax E-mailRotarian? Yes No Rotarian? Yes No Sponsoring Rotary Club and DistrictThe Rotary Club of and District , having interviewed the applicant and his/her parents/legal guardia

40、ns and reviewed the students application, hereby endorse the student as meeting the qualifications for Rotary YouthExchange and recommend to hosting clubs the acceptance of this student. The District agrees to provide adequate orientation to the studentand parents before departure, and will, will no

41、t, host an Inbound. Type - Club President Type - Club Secretary/YEO Type - District YE Chairperson* * * Sign - Club President Date Sign - Club Secretary/YEO Date Sign - District YE Chairperson Date If “Yes,” Name of Rotary Club If “Yes,” Name of Rotary ClubRotary Youth Exchange Program Application 1

42、Program Rules and Conditions of Exchange1) Obey the Laws of the Host Country If found guilty of8) The student must abide by the rules and conditions ofviolation of any law, student can expect no assistance fromexchange of the Hosting District provided to you byRotary or their native country. Student

43、 will be returnedthe District Youth Exchange Committee.home as soon as released by authorities.9) The student must return home directly by a route2) The student is not allowed to possess or use illegal drugs. mutually agreeable to the Host District and studentsMedicine prescribed by a physician is a

44、llowed.parents.3) The student is not authorized to operate a motorized 10) The student shall have sufficient financial supportvehicle of any kind which requires a federal/state/ to assure his/her well-being during the vincial license or participate in driver education Any unusual costs r

45、elative to a students early returnprograms. home or other unusual costs shall be the responsibility4) The illegal drinking of alcoholic beverages is expressly of the students own parents/guardians.forbidden. Students who are of legal age in host country 11) You will be under the Hosting Districts au

46、thorityshould refrain. while you are an exchange student. Parents/guardians5) Stealing is prohibited. There are no exceptions. must avoid authorizing any extra activities6) Unauthorized travel is not allowed. Students must follow directly to their son/daughter. The Host Club and the travel rules of

47、the Host District. District Youth Exchange officers must authorize such7) The student must be covered by a health and life insurance activities. Relatives in the host country will have nopolicy agreeable to the Hosting District. authority over the student while they are in theIn consideration of the

48、 acceptance and participation of the applicant in such program, the undersigned APPLICANT and his orher PARENTS or Legal GUARDIANS, to the full extent permitted by law, hereby release and agree to save, hold harmless andindemnify, all host parents and members of their families, and all members, officers, directors, committee members andemployees of host and s