Area Representative Evaluation Report
MAY
Name of Area Representative Completing This Form:
*
First Name
Last Name
Student's Name:
*
First Name
Last Name
Exchange program season:
*
2023/2024 School Year
2024/2025 School Year
Student's Gender:
*
Female
Male
Student's Home Country:
*
Host Family Name:
*
Host Family Location:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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 the month of 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:
*
1
2
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Please use the following scale to rate the student and host family experience, and interaction:
*
Excellent
Good
Fair
Needs improvement
Student's care and love towards the host family.
Overall relationship between student and 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
Student's English skills
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 continue to go between the student and host family? What are some of the special moments that they have shared recently? Please explain:
*
Please share the types of activities the student did with the host family or/and with school friends during this past school year:
*
Please share any additional questions or concerns about this placement:
*
Would the host family consider hosting again?
*
Yes. They would consider again.
No. They did not have the best experience.
Other
Area Representative Signature
*
Today's Date:
*
/
Month
/
Day
Year
Date
Area Representative E-mail.
*
example@example.com
Submit
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