Youth Exchange Program District 3360 Thailand Monthly Report Form
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 informally): 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/links):
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?