Monthly Report
FirstName *
LastName *
Email *
Today's Date *
MM
/
DD
/
YYYY
Your Current Mobile Phone Number *
Host Club Counsellor Name *
Host Club Counsellor Email Address *
Host Parent/s Name/s *
Host Family Home Address *
Host Parent/s Contact Email/s *
Next Host Parent/s Name/s *
Next Host Family Home Address *
Expected Moving Date *
MM
/
DD
/
YYYY
Contact With Sponsor Club *
Please tell us the date you contacted your Sponsor Club, how you did it (email? postcard?) and the name of the person you contacted.
Language Proficiency *
Low
Excellent
What are you working on in your language proficiency at the moment? *
Places of Interest Visited *
School, Social and Sporting Activities *
Contact with other Exchange Students *
Relationship and Activities with your Host Family *
Relationships and Activities with your Host Club and Club Counsellor *
Rotary Meetings / Functions Attended *
Publicity Received and Public Speaking *
Future Trips / Travel Planned *
Challenges/Issues you would like to raise *
(e.g. hosting, school, language, relationships with club/counsellor, etc)
Comments or Suggestions
Coordinator *
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