Student Name:
Student E-mail:
Date:
Sponsor Rotary Club:
Details of Hosting Club
Host Rotary Club:
Host Rotary Club District:
Host Club Mentor’s Name:
Mentor’s Address:
Mentor’s Telephone Number:
Mentor’s E-mail:
Details of Present Host Family
Host Family Name:
Host Family Address:
Host Family Telephone Number:
Host Brothers & Sisters (Sex/Age) eg None, M/17, F/6, etc
Details of Next Host Family Note: You must put something in these fields even if it’s “Don’t know”
Host Family Name:
Host Family Address:
Host Family Telephone Number:
Date of Anticipated Transfer:
Amount of Pocket Money received per month:
On Time? Yes No
Give a brief account of your contact with your Host Mentor since your arrival:
What contact has been made between Sponsor and Host Clubs (Emails, Letters, CDs Bulletin exchanges, etc) since your arrival? What have you done to promote contact between Sponsor and Host Clubs?
What contact have you had with your Sponsor Club / Mentor (in WA) since your arrival?
Detail your pre-departure contact with: Host District Officer
Host Families
Host Rotary Club
Comment on and detail any problem areas encountered between your departure from your home in Australia and your arrival at your final destination in your Host Country.
Please comment on assistance given by Turtle Travel.
Did your luggage go astray? Yes
If Yes , how long before you received it back?
Did you need to use the baggage insurance? Yes
If Yes , were there any problems?
Did you post any clothes/books etc. to your first host home? If so, number of parcels, approx weight.
What type of gifts did you select for your host families?
(Detail if appropriate) What is your relationship with your: Host Family
Host Club
Host Mentor
School
What subjects are you studying at School?
At what level? Year 11 or Year 12?
Comment on available subject choice at School, sports facilities, cultural societies etc.
General (include comments, suggestions, complaints, impressions etc. Of particular importance are ways to improve the District 9450 Exchange Program).
Activities Report Note: You must put something in ALL fields of the Activity Report, even if it’s “Not applicable”.
Rotary Meetings attended
Public Speaking engagements and topics of talks
What is your total number of talks to date?
Examples of the type of questions asked by the audience
Press, Radio & TV interviews
Contact with other Exchange Students
Give brief details of your social and sporting activities
Comments on any aspect of the Activities Report
After completing ALL fields, click on the “Submit” Button to e-mail this report to your District 9450 Placement Officer. You will be transferred immediately to a confirmation webpage if you have successfully sent your report.
