04 - Area Representative Evaluation Report
NOVEMBER
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 use the following scale to rate the student's experience thus far based on your recent communication with the STUDENT, as well as your personal observations.
*
Rows
Positive
Fair
Negative
Needs Improvement
Host Family's Love and Attention Towards the Student
Host Family's Support for the Student
Overall Relationship between the Host Family and the Student
Student's Interest in Involving Him/Herself in the Host Family's Activities
Student's Experience at School
Student's Interaction with Friends
Please select the dates that you communicated with the STUDENT during the month of November.
*
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Please select the ways in which you communicated with the STUDENT in November.
*
E-mail
Phone Call
Text Message
Facebook Messaging
In Person Visit
WhatsApp Communication
Instagram Messaging
Zoom
Skype
Other
Please use the following scale to rate the host family's experience based on recent communications you have had with them, as well as your personal observations. The following categories are focused on how the host family feels about the student and their experience overall.
*
Rows
Excellent
Good
Fair
Needs improvement
Student's Care and Love Towards the Host Family
Overall Relationship between the Student and the Host Family
Student's Interest in Involving Him/Herself in the Host Family's Activities
Host Family's Communication with the Student
Student's Behavior at Home
Student's Academic Performance at School
Student's Behavior at School
Please select the dates that you communicated with the HOST FAMILY during the month of November:
*
1
2
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Please select the ways in which you communicated with the HOST FAMILY in November:
*
E-mail
Phone Call
Text Message
Facebook Messaging
In Person Visit
WhatsApp Communication
Instagram Messaging
Zoom
Skype
Other
Please describe any activities the student is involved in at school. Has the student joined any sports or other extracurricular activities? What plans, if any, do the student and host family have for the Thanksgiving holiday?
*
If you wish to elaborate on the questions above, please use this space to share additional concerns, comments or questions.
*
Area Representative's Electronic Signature:
*
Today's Date:
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Your E-mail Address:
*
example@example.com
Submit
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