STUDENT COUNSELOR CONTACT MONTHLY FORM

Rotary Youth Exchange ● District 5190 ● California/Nevada
Serving the youth of Eastern California and Northern Nevada

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CLUB COUNSELOR CONTACT MONTHLY FORM

This form is used by the Host Rotary Club Counselor to record the results of the required host student contacts. The host counselor is to meet with RYE inbound student at least once a month without the host family. The counselor also will meet with the host family without the student on a monthly basis. Lastly, the counselor is to be in contact with the RYE Student's school on a monthly basis.

Note: You MUST press the TAB key to move from field to field. Pressing the ENTER or RETURN key will result in an error message or will submit the data for processing before you have finished completing the form.
Month of Report
Name of Student
Home Country
Host Rotary Club
Counselor
Counselor's email
Counselor's phone
Student Contact (This is a narrative about your contacts with the student)
Host Family Contact (This is a narrative about your contacts with the host family)
SCHOOL INFORMATION
School Name
School Contact name
Position
School Contact (This is a narrative about your contacts with the student's school)
COUNSELOR'S SUMMARY
Overall my student is doing	Select from drop down box
Please Contact me
Other Comments
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