Area Representative Evaluation Report
APRIL
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
2025/2026 School Year
2026 Semester
Student's Name:
*
First Name
Last Name
Exchange 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 experience based your recent communication with the STUDENT, as well as your personal observations.
*
Rows
Excellent
Good
Fair
Needs Improvement
Overall Relationship between the Host Family & the Student
Student's Adaptation to American Culture
Student's Experience at School
Student's English Improvement
Student's Participation in Activities
Student's Grades
Student's Behavior
Student's Care and Attitude Towards the Host Family
Please select the dates that you communicated with the STUDENT during the month of April:
*
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Please select the ways in which you communicated with the STUDENT in April.
*
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 your recent communication with the family, as well as your personal observations.:
*
Rows
Excellent
Good
Fair
Needs improvement
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
Host Family's Care Towards the Student
Host Family's Interaction with the Student
Host Family's Overall Opinion of the Cultural Exchange Program
Please select the dates that you communicated with the HOST FAMILY during the month of April.
*
1
2
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5
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30
Please select the ways in which you communicated with the HOST FAMILY in April.
*
E-mail
Phone Call
Text Message
Facebook Messaging
In Person Visit
WhatsApp Communication
Instagram Messaging
Zoom
Skype
Other
Please share any additional questions, concerns or comments you may have about this placement.
*
Area Representative's Electronic Signature:
*
Today's Date:
*
/
Month
/
Day
Year
Date
Your E-mail Address:
*
example@example.com
Submit
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