Monthly Report – Inbound

Student

Name*

First Last

Home Country*

Your USA Cell Phone Number*

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?*

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?*

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*

Course of Study Grade (A-B-C-D-F)

Speaking*

Understanding*

Host Family*

Teachers*

Students*

RYE Counselor*

Host Rotary Club*

Number of Rotary meetings attended this month?*

Are you receiving your monthly allowance?*

How Much?*

On Time?*

Name

This field is for validation purposes and should be left unchanged.