Rotary District 5440 Youth Services

ROTARY DISTRICT 5440 NEW GENERATIONS PROGRAMS Bobbe Fitzhugh, Chairman 873 Esterbrook Road, Douglas, WY 82633 USA 307-358-6457 (home) 307-359-3311 (mobile) [email protected]

ROTARY DISTRICT 5440 YOUTH SERVICES CLUB MEMBER TRAINING ROSTER

2014-2015 Program Year

Pursuant to Rotary International and District 5440 adopted policies on the protection of participants in Rotary Youth Exchange activities, all volunteers who participate in any Youth Service Avenue of Service program shall participate in at least one initial training session and undergo annual refresher training in which the youth protection policies and procedures are explained and discussed. Training requirements may be met on-line or through attendance at a district-sponsored training session.

A Youth Services online training module may be accessed by clicking on the Youth Protection On-line Training icon on the District 5440 website www.rotary5440.org. Clubs may then certify on page two of this document that they have completed the on-line training module.

*In addition to the general on-line training module for all Youth Service programs, Long-term Youth Exchange has an additional training and certification requirement mandated by the Department of State. Each Club Chairman (YEO) must complete the annual Department of State online training module pursuant to 22 CFR 62.25(d)(1) to receive certification. Once the name and email address for club YEOs is submitted on the annual compliance agreement, the District DOS Responsible Officer will provide each YEO with login information to complete the module. Successful passage of the online examination is required for final certification. ROTARY DISTRICT 5440 NEW GENERATIONS CLUB MEMBER TRAINING ROSTER

2014-2015 Program Year

I certify that the following individuals representing ______Rotary Club completed the North American Youth Exchange Network on-line training provided.

______Name Title Date

completed

(use additional sheet if necessary)

______Club Representative Signature Date

Upon completion, please email, fax or mail completed form to: Kellie Tovar, Administrative Secretary [email protected] 970-506-1036 (fax) 3729 West 22nd St. Greeley, CO 80634