02 - Area Representative Evaluation Report
SEPTEMBER
Name of Area Representative Completing This Form:
*
First Name
Last Name
Student's Name:
*
Please Select
1. Catarina Menossi
2. Gabriel Aupetit
3. Gabriella Brasil
4. Inigo Elorriaga
5. Isaac Abreu
6. Isaac Braga
7. Isabella Hervella
8. Martina Baudo
9. Mauro Sanchez
10. Samuel Quirino
11. Sara Munoz
12. Vinicius Fernandes
Student's Gender:
*
Female
Male
Student's Home Country:
*
Please Select
Brazil
China
France
Germany
Italy
Slovakia
Spain
Program Season:
*
Please Select
2025/2026 School Year
Host Family's Name:
*
Host Family's Location:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please describe the relationship between the student and the host family? Are they getting along? What are some activities the student has participated in so far?
*
How is the student doing in school? Has the student made any friends? Has the student joined any sports, clubs or other activities?
*
Please use the scale below to rate the student's experience based on communications you have had with him/her, as well as your personal observations.
*
Rows
Very Satisfied
Satisfied
Neutral
Not Satisfied
Host Family's Interaction with the Student
Host Family's Support Towards the Student
Host Family's Care Towards the Student
Host Family's Interest in Learning about the Student's Culture
Student's Communication with the Host Family
Student's Feelings about Living in the Current Community/Neighborhood
Student's Overall Opinion/Feeling about the Cultural Exchange Experience
Please select the dates that you communicated with the STUDENT during the month of September:
*
1
2
3
4
5
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9
10
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12
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Please select the ways in which you communicated with the STUDENT during the month of September. Please note that as per U.S. Department of State regulations, the first communication that you have with the student after his/her arrival in the U.S. MUST be completed IN PERSON:
*
E-mail
Phone Call
Text Message
Facebook Messaging
In Person Visit
WhatsApp Communication
Instagram Messaging
Zoom
Skype
Other
Please use the scale below to rate the host family's experience based on the communications you have had with the host family, as well as your personal observations.
*
Rows
Very Satisfied
Satisfied
Neutral
Not Satisfied
Student's Interaction with the Host Family
Student's Behavior at Home
Student's Communication with the Host Family
Student's Grades and Academic Performance
Student's Adaptation to the American Culture
Host Family's Overall Opinion of Their Experience Hosting the Student
Please select the dates that you communicated with the HOST FAMILY during the month of September:
*
1
2
3
4
5
6
7
8
9
10
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18
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25
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30
Please select the ways in which you communicated with the HOST FAMILY during the month of September. Please note that as per U.S. Department of State regulations, you MUST communicate with the host family at least once in person during the first semester of the program and once in person during the second semester of the program.:
*
E-mail
Phone Call
Text Message
Facebook Messaging
In Person Visit
WhatsApp Communication
Instagram Messaging
Zoom
Skype
Other
Are there any other observations or concerns to report about this placement?
*
Area Representative's Electronic Signature:
*
Today's Date:
*
/
Month
/
Day
Year
Date
Your E-mail Address:
*
example@example.com
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