ROTARY
INTERNATIONAL YOUTH
DISTRICT 9970 EXCHANGE
NEW ZEALAND PROGRAMME
Youth Exchange 9970 Inbound Report (v2)
Please provide the following information each month during your exchange. Be honest with your responses and
inform us of anything you feel is important for us to know. If we are not aware of a problem we cannot help you.
(Any matters you wish to remain confidential, please mark “Confidential”)
Reports due MONTHLY – end of the month
Forward your report to Murray (rye.chair@rotary9970.org.nz) & Shona / Roger
(rye.ib@rotary9970.org.nz)
Report Month
Student's name Date:
Host Club overseas
Counsellors name Telephone:
Address:
Email:
Non-Rotarian Contact #1
Non-Rotarian Contact #2
Present host family name:
Address: Telephone Home:
Email: Telephone Work:
Names and ages host brothers and sisters:
Next host family name: Mum: Dad:
Address
Telephone Home:
Email:
Telephone Work:
Date of anticipated transfer to next family:
Do You Have Any Money Problems? YES/ NO If the answer is yes please comment
Has Your Counsellor Discussed Your Budget With You Lately? YES/ NO
Are You Receiving Your Monthly Payment From Your Host Club Regularly? YES/ NO
Do You Have Any Health Problems? YES/ NO: If the answer is yes please comment
Are You Having Any Language Problems? YES/ NO: If the answer is yes please comment
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Have you settled in well with your hosts? YES/ NO: If the answer is no please comment
Please comment if you are feeling homesick/alone/scared
List your involvement and results at school:
Comment on School & Exchange High points/Low points
How often do you attend Host Club meetings?
What other Rotary and non-Rotary meetings have you attended?
Have you been hosted by other members of your club for a meal or a trip? YES/ NO
Are you corresponding regularly with your family back home? YES/ NO
What contact has been made between yourself and your sponsor club in your home Country?
Is everything OK? YES/ NO If no, can we help? YES/ NO
Does your counsellor know? YES/ NO
On a scale (Excellent / Good / Average / Poor/ Awful rate the relationship with each of the
following:
Host Club Counsellor
Current Host Family School Friends
Please explain any unsatisfactory relationships and how you think they can be improved:
Other Comments:
(This space could include comments, suggestions, requests, impressions, problems, complaints
etc. Anything different or unexpectedly similar to home, or just news. Suggestions to improve
your Youth Exchange Programme are especially important)
RYE 9970 Website:
Please write a paragraph for us to include on our website about your exchange. We would also
welcome a picture or two. (Have you supplied your introductory paragraph yet?)
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