Student Exchange Program Application Logo

  • Application Packet

  • Student Biography

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  • Personal Essays

    Please, answer each prompt using complete sentences and paragraphs.

  • Code of Conduct

  • STUDENT AGREEMENT

    I understand that any violation of American or Japanese laws, failure to follow all of the above mentioned criteria, persistent disobedience of rules or instructions, or disruptive or inappropriate behavior will result in disciplinary action as deemed necessary by those in positions of authority. Such disciplinary measures may include being sent home at the expense of my legal guardian/parent and dismissal from continued participation in the Program.
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  • PARENT/GUARDIAN AGREEMENT

    As the legal guardian/parent of this student exchange participant, I understand this is a family commitment and I am willing to be actively involved in the process. I have read and understood my child’s expectations as described in the “Student Ambassador Code of Conduct Policy”. I also understand and agree it is my sole responsibility to cover all travel and processing expenses should my child be sent home due to their actions. I will help my child stay responsible as a student exchange participant for the duration of his/her participation in this Program.
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  • PARENT Commitment Form

  • Student Acknowledgment of Commitment

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  • Parent/Guardian Acknowledgment

    By signing this agreement, you are agreeing to participate fully in the program and acknowledge the responsibilities we have outlined above. Again, due to the nature of this program, please understand that failure to meet these commitments could result in your child's dismissal. We look forward to working with you to make this once-in-a-lifetime experience for you and your child!
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  • Teacher Questionnaires & Letters of Recommendation

  • THREE Teacher Questionnaires and TWO Letter of Recommendation are required to complete your application packet.

    There are multiple ways for submission of these elements:

    1. Online Submissions:
      • Teacher Questionnaire Link (Copy this link and send it to your teachers for their online submission):
        •  https://forms.gle/yb71vLndq1i1wAc49
      • Letter of Recommendation Link (Copy this link and send it to your selected recommenders):
        • https://forms.gle/Kd8kgT5FT2wrSYRM6
    2. File Uploads: Attach pictures, or digital files, below for submission. 
    3. Physical Submissions: contact Eric Fullerton at StudentCoordinator@RoseburgSisterCities.org to coordinate physical form submissions.
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  • Submission

  • Amazing work!

    You've made it to the submission page...now take a deep breath and click that button!!!

    We are so excited to review your application. You will receive an email once we have ALL aspects of the application packet completed with an acknowledgement of the completed packet, as well as a general timeline for an offer of acceptance or declination.

    Once the completed packet is reviewed, an Administration Check will be performed by the Student Exchange Coordinator with your/your child's attending school. After the Administration Check is completed, the application will be reviewed by members of the Roseburg Sister Cities, Inc.'s Board and voted on by a panel of three members. After these steps, we will then reach out to let you know our decision related to your application.

    If we receive more applications than open slots, we will contact all applicants and coordinate Student Interviews to help determine which students to accept into the program.

    If you have any questions, comments, or concerns contact:

    Eric Fullerton at StudentCoordinator@RoseburgSisterCities.org 

    We look forward to reviewing your application!

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