Area Representative Initial Evaluation Report (September 2023)
ARISE (Association Representing International Student Exchange)
Name of the Area Representative who is completing this form:
*
First Name
Last Name
Student's Name:
*
Please Select
ALFONSO M.
BEATRIZ B.
CANDELA M.
DANIELA DE OLIVEIRA
DANIELA FERRERA
ERIC C.
GUILLERMO H.
GUSTAVO B.
JAKOB G.
JOAO FELIPE RIBEIRO
JOAO VITOR GIROUX
JORGE N.
JUDITH A.
LEVI P.
LOLA V.
LUKAS G.
NICOLE S.
PAULA T.
Exchange program reason:
*
FALL 2023 School Year
FALL 2023 Semester
SPRING 2024 Semester
Student's Gender:
*
Female
Male
Student's Home Country
*
Please Select
BRAZIL
FRANCE
GERMANY
ITALY
SPAIN
Host Family Name:
*
Host Family Location:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please describe how the relationship is with the student and host family? Are they getting along? What are the activities that the student has joined so far?
*
How is the student doing at school? Has the student made any friends? Is the student joining any sport or activities?
*
Please use the information below to describe the student's experience based on the communications you had with the student.
*
Very Satisfied
Satisfied
Neutral
Not Satisfied
Host Family Interaction with the student
Host Family support toward the student
Host Family care towards the student
Host Family interest to learn about the student's culture
Student's communication with the host family
Student's feelings towards living in the current community/neighborhood.
Student's overall option/feeling about the current cultural exchange experience
Please use the information below to describe the Host Family's experience based on the communications you had with the host family.
*
Very Satisfied
Satisfied
Neutral
Not Satisfied
Student 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 towards the American culture
Host family overall option on the experience hosting the student
Please select the dates that you communicated with the STUDENT during the month of September:
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Please select the ways in which you communicated with the STUDENT.:
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E-mail
Phone Call
Text Message
Facebook Messaging
In Person Visit
WhatsApp Communication
Instagram Messaging
Zoom
Skype
Other
Please select the dates that you communicated with the HOST FAMILY during the month of September:
*
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Please select the ways in which you communicated with the HOST FAMILY:
*
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 Signature
*
Today's Date:
*
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Month
/
Day
Year
Date
Your E-mail address
*
example@example.com
(Please don't complete this section) This space is for ARISE's staff main office for notes.
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