Rotary Youth Exchange District 6250 Monthly Report
For Inbound Students only. Please complete this form every month.

If you have any questions or problems, please contact Inbound Coordinator, Bill Pritchard at (608) 780-2637 or pritchardbpjp@charter.net

Student Name *
First and Last
Your answer
Student Home Country *
Your answer
Host Rotary Club Name *
Your answer
Student Email Address *
Your answer
Student Cell Phone Number
USA Cell Phone
Your answer
YEO Name *
First and Last
Your answer
YEC Name *
First and Last
Your answer
Current Host Family Names *
Parent(s) Names
Your answer
Current Host Family Address *
Your answer
Current Host Family Home Phone *
home or cell number
Your answer
Current Host Family Email Address *
Your answer
Next Host Family Name
Parent(s) Names If known...
Your answer
Date of anticipated move to next host family
If known...
MM
/
DD
/
YYYY
Activities since last report:
Tell us about your activities, such as public speaking engagements, social activities, places of interest you visited, contact with other exchange students and community projects and any newspaper, radio or television interviews. *
Your answer
What subjects are being studied at school? (If no change, so indicate.) *
Your answer
How is your language proficiency progressing? *
Your answer
Rotary activities since last report
Number of Rotary club meetings attended *
Your answer
Have you attended any Rotary Youth Exchange meetings or conferences? *
Explain
Your answer
Are you receiving your allowance regularly? *
If you are receiving you allowance, how much do you get each month?
Your answer
Are you helping your Rotary club with a community service project? *
Explain
Your answer
Are you corresponding regularly with your family in your home country? *
Explain
Your answer
How is your relationship with your host family? *
Your answer
How is your relationship with your school and other students? *
Your answer
How is your relationship with your host Rotary Club including your YEO and YEC? *
Your answer
Have you met with your YEO or YEC this month? *
Explain
Your answer
Optional Section
If you are having any difficulties or problems, please tell us about them. Don't hesitate to also tell us about the good times as well. Include any comments, suggestions, requests, complaints or impressions you may wish to share with us.
Your answer
If you are reporting a problem, is it severe enough for us to intervene at this time?
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