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Host Family Reference Contacts – Youth Exchange Officer

Host Family Reference Contacts – Youth Exchange Officer

After reviewing the family’s references, 3 contacts and 1 family member, the Youth Exchange Officer should submit this form.

The Country Contact, the YEO, and the district will be copied on the form confirmation email.

Host Family Reference Check

Host Family Last Name(Required)

Host Club Name(Required)

Student Home Country(Required)

Country Contact Email(Required)

YEO Name(Required)

First Last

YEO Email(Required)

Did you, the YEO, contact all references?

Yes

No

References Contacted

2 out of the 3 references not related to the family must be contacted. Please make every effort to speak with all 3 references. List all references in this form.

Reference 1(Required)

First Last

Date Contacted 1(Required)

MM slash DD slash YYYY

Method 1(Required)

Phone

In Person

Results 1(Required)

Brief description of conversation.

Interviewer Name 1(Required)

First Last

Reference 2(Required)

First Last

Date Contacted 2(Required)

MM slash DD slash YYYY

Method 2(Required)

Phone

In Person

Results 2(Required)

Brief description of conversation.

Interviewer Name 2(Required)

First Last

Reference 3(Required)

First Last

Date Contacted 4(Required)

MM slash DD slash YYYY

Method 3(Required)

Phone

In Person

Results 3(Required)

Brief description of conversation.

Interviewer Name 3(Required)

First Last

Relative

The reference related to the family must be contacted.

Reference 4(Required)

First Last

Family Member Reference

Date Contacted 4(Required)

MM slash DD slash YYYY

Method 4(Required)

Phone

In Person

Results 4(Required)

Brief description of conversation.

Interviewer Name 4(Required)

First Last

General Comments(Required)

Recommend to Host(Required)

Yes

No

YEO Signature

Δ

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