This report is confidential between student and the
District 9790 Youth Exchange Committee.
It is used to detect spammers.
If you enter anything into this text box, your message
will not be sent.
Month and Year:    Select the report month
Your Name:
Your email:
Host Club:
Host District:
Host Country:
Counsellor:
Address:
Tel AH:
Tel BH:
Fax:
Sponsor Club:
Counsellor:
Address:
Tel AH:
Tel BH:
Fax:

Present Host Family
Name:
Address:
Tel AH:

Next Host Family
Name:
Address:
Tel AH:
Date of expected change:         
Until:
Information required.  Since your last monthly report:
Have you contacted your parents?   Yes    No
Have you contacted your host club counselor?   Yes    No
Have you contacted your sponsor club?   Yes    No
Have you experienced any difficulties with your host family?   Yes    No
If "Yes" please comment here:
Have you experienced any difficulty with your Host Club?   Yes    No
If "Yes" please comment here:

Have you experienced any difficulty with your school?   Yes    No
If "Yes" please comment here:

Have you tried to resolve these difficulties?   Yes    No
If "Yes" please comment here:

Have you attended a meeting of your host club?   Yes    No
If "No" why not -  please comment here:
Have you attended any other Rotary Club meetings?   Yes    No
Have you performed any public speaking engagements?   Yes    No
Have you participated in any non Rotary activities, sporting or social?   Yes    No
Have you had any illness or injury?   Yes    No
If "Yes" please comment here:
Can the District 9790 Committee do anything to assist your exchange?   Yes    No
Please use this space to
expand on the above answers:

There is plenty of space for 
lengthy comments if needed.
Details of the 
report months travel:

There is plenty of space for 
lengthy comments if needed.
Details of the 
next months
and future  travel:

There is plenty of space for 
lengthy comments if needed.
Any additional information:

There is plenty of space for 
lengthy comments if needed.

 
Last Updated: Tuesday June 10, 2008 11:39