Monthly Report Form

Rotary Youth Exchange

Student's Monthly Report Form

Please complete each box below, then choose the recipient(s), and click the button at the foot in order to submit your monthly report.

Student Info

Student Name:

Sponsor Club:

Email Address:

Host Counsellor:

Host Club:

Host Family Info

Name:

Address:

Phone Number:

Monthly Report for: (select month)

A. Your Health:

B. School Activities:

C. Attendance at Rotary Functions:

D. Activities Outside Rotary:

E. Comments and Requests:

Select YE Committee member that wish to send your report to: (choose from list in pull-down menu)
Optional - send an additional copy of this report to: (insert additional email address)
Optional - send an additional copy of this report to: (insert additional email address)
Optional - send an additional copy of this report to: (insert additional email address)