Monthly Report — Outbound – Rotary Youth Exchange, District 6220

Student

Name*

First Last

Email*

Host Country*

Host Parent Name*

Address*

Street Address Address Line 2 City Country

Phone*

Host District Chairman*

Email

Phone

Host RYE Officer*

Email

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 tell us about your RYE Conferences

Speaking*

Understanding

Host Family*

Teachers*

Students*

RYE Officer*

Sponsoring Club*

Number of Rotary meetings attended this month?*

Are you receiving your monthly allowance?*

How much each month?*

On Time?*

Phone

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