Monthly Report – Inbound

Student
Name*
First Last
Home Country*
Your USA Cell Phone Number*
Current Address
Host Parent Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Host Club*
Host RYE Officer*
RYE Officer's Email
RYE Officers Phone
Do you want to keep this section confidential?*
- Yes
- No
- Don't Care
If you are having any difficulties or problems, please tell us about them*
What have you done to resolve them?*
Is it severe enough for us to intervene at this time?*
- Yes
- No
Please tell us about your life!*
Please write at least five sentences describing your current life as a Rotary Youth Exchange student!
Please tell us how you feel about the school you are attending*
Subjects you are taking in school
Course of Study Grade (A-B-C-D-F)
Course of Study Grade (A-B-C-D-F)
Course of Study Grade (A-B-C-D-F)
Course of Study Grade (A-B-C-D-F)
Course of Study Grade (A-B-C-D-F)
Course of Study Grade (A-B-C-D-F)
Course of Study Grade (A-B-C-D-F)
Course of Study Grade (A-B-C-D-F)
Course of Study Grade (A-B-C-D-F)
Please rate your language ability: (1= poor, 10 = excellent)
Speaking*
Understanding*
Please rate your relationships with: (1= poor, 10 = excellent)
Host Family*
Teachers*
Students*
RYE Counselor*
Host Rotary Club*
Number of Rotary meetings attended this month?*
Are you receiving your monthly allowance?*
- Yes
- No
How Much?*
On Time?*
- Yes
- No
Phone
This field is for validation purposes and should be left unchanged.

Student