EmailMe Form - Youth Exchange Program District 3360 Thailand

Youth Exchange Program District 3360 Thailand
Monthly Report Form

For the month of

Student's Thai Name

Student's Name

Date

YYYY

Sponsor (Home) Club

District

Host Rotary Club

District

Host Counselor's Name

Address

Street Address
Address Line 2
City	State / Province / Region
Postal / Zip Code	Country

Phone Number

###

####

Fax

Email

Information about present host family

Present Host Family

Address

Street Address
Address Line 2
City	State / Province / Region
Postal / Zip Code	Country

Phone Number

###

####

Fax

Email

Name & ages of host parents children

Information about next host family

Next Host Family

Address

Street Address
Address Line 2
City	State / Province / Region
Postal / Zip Code	Country

Phone Number

###

####

Fax

Email

Expected date of transfer

Activities Since Last Report

Rotary Meetings Attended

Public speaking engagements (give details of groups you have spoken to either formally or information):

Topics Covered:

Questions Asked:

Places of Interest Visited:

Social and sporting activities (include visits to private homes):

Contact with other Exchange students:

Publicity received (Attach Clipping):

School activities:

Subjects studied (if Changed):

How is your language proficiency progressing?

How is your relationship with:

Your host family?

Your Club Counselor?

Members of your Host family?

Your fellow School students?

Any Problem?

What trips are you planning? With whom? When?

Any comments, suggestions, requests or impressions?

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