Area Representative Evaluation Report
MAY
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 Name:
*
First Name
Last Name
Student's Gender:
*
Female
Male
Student's Home Country:
*
Please Select
Brazil
China
France
Germany
Italy
Slovakia
Spain
Student's Home Country:
*
Program Season:
*
Please Select
2024/2025 School Year
Program Season:
*
2023/2024 School Year
2024/2025 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 and host family's overall experience.
*
Rows
Excellent
Good
Fair
Needs improvement
Student's Care and Love towards the Host Family
Overall Relationship between the Student and the Host Family
Host Family's Care and Love towards 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 STUDENT during the month of May:
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Please select the ways in which you communicated with the STUDENT in May:
*
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 May:
*
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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
How are things continuing to go between the student and host family? What are some of the special moments that they have shared recently? Please describe:
*
Please share the types of activities the student participated in with the host family and/or with school friends during this past school year:
*
Please share any additional questions or concerns about this placement:
*
Would the family consider hosting again?
*
Yes. They would consider again.
No. They did not have the best experience.
Other
Area Representative's Electronic Signature:
*
Today's Date:
*
/
Month
/
Day
Year
Date
Your E-mail Address:
*
example@example.com
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