Monthly Report
FirstName *
Your answer
LastName *
Your answer
Email *
Your answer
Today's Date *
MM
/
DD
/
YYYY
Your Current Mobile Phone Number *
Your answer
Host Club Counsellor Name *
Your answer
Host Club Counsellor Email Address *
Your answer
Host Parent/s Name/s *
Your answer
Host Family Home Address *
Your answer
Host Parent/s Contact Email/s *
Your answer
Next Host Parent/s Name/s *
Your answer
Next Host Family Home Address *
Your answer
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.
Your answer
Language Proficiency *
Low
Excellent
What are you working on in your language proficiency at the moment? *
Your answer
Places of Interest Visited *
Your answer
School, Social and Sporting Activities *
Your answer
Contact with other Exchange Students *
Your answer
Relationship and Activities with your Host Family *
Your answer
Relationships and Activities with your Host Club and Club Counsellor *
Your answer
Rotary Meetings / Functions Attended *
Your answer
Publicity Received and Public Speaking *
Your answer
Future Trips / Travel Planned *
Your answer
Challenges/Issues you would like to raise *
(e.g. hosting, school, language, relationships with club/counsellor, etc)
Your answer
Comments or Suggestions
Your answer
Coordinator *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.