Youth Exchange Program District 3360 Thailand

For the month of
Student's Thai Name
Student's Name
Date

MM
/
DD
/
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?
Image Verification
captcha
Please enter the text from the image:
[Refresh Image] [What's This?]