Rotary Youth Exchange Monthly Report

Rotary Youth Exchange Monthly Report
Report Month *
Student Name *
Email Address *
example@example.com
Student Mobile *

Area Code Phone Number
Club Co-ordinator Name *
Club Co-ordinator Phone

Area Code Phone Number
Club Co-ordinator Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Club Co-odrinator Speak English? *

Yes No
Host Family Name *
Host Family Phone *

Area Code Phone Number
Host Family Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Host Family Speak English? *

Yes No No, but it's OK, neither do I
Next Host Name
Next Host Phone

Area Code Phone Number
Next Host Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Expected Transfer Date (if known)

Day Month Year
If none of the above speak English, is there someone you can talk to?

Yes No
Who can you speak to and what is their relationship to you (e.g. teacher, Rotarian, friend)?
Places of interest visited
Social and Sporting Activities
Contact with other Exchange Students
Publicity Received (include links if possible)
School Activities
Language Proficiency
The following section relates to the relationships you have with various people in your host country.

Please describe each relationship, in terms of:
- the type and frequency of communication (i.e. how often you see or speak to them)
- your feelings about the relationship (i.e. is it positive, do you feel comfortable, do you enjoy their company)
- anything else you feel is important (i.e. good / bad experiences, reflections, etc.)
With host family
With Club and Club co-ordinator
With fellow students
Planned trips
Challenges
Health Issues
Activities since last report
Rotary meetings and functions attended
Public speaking
Are you receiving your monthly allowance? *

Yes No Sometimes
Your Co-ordinator *
Are you having fun? *
Comments or suggestions
Should be Empty:

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