Area Representative Evaluation Report
JANUARY
Name of Area Representative Completing This Form:
*
First Name
Last Name
Student's Name:
*
Please Select
Catarina Menossi
Gabriel Aupetit
Giulia Bartolozzi
Heitor Pusch
Inigo Elorriaga
Isaac Abreu
Isaac Braga
Isabella Hervella
Martina Baudo
Mauro Sanchez
Samuel Quirino
Sara Munoz
Vinicius Fernandes
Student's Gender:
*
Female
Male
Student's Home Country
*
Please Select
Brazil
China
France
Germany
Italy
Slovakia
Spain
Program Season:
*
Please Select
2024/2025 School Year
Exchange program season:
*
January 2024
August 2023 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 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 Towards the Student
Overall Relationship between the Host Family and the Student
Student's Interest in Interacting and Being Involved with the Host Family
Student's Experience at School
Student's Interaction with American Friends
Please select the dates that you communicated with the STUDENT during the month of January:
*
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Please select the ways in which you communicated with the STUDENT in January:
*
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 the exchange experience to date.
*
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 Being Involved with the Host Family and Their 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 January:
*
1
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Please select the ways in which you communicated with the HOST FAMILY in January. 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
Please describe the current relationship between the student and the host family. Are they getting along well? Please be detailed in your response.
*
If you wish to elaborate on the questions above, please use this space to share additional concerns, comments or questions.
*
Evaluation Month:
*
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
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