Pre-Outbound Report

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

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STUDENT MONTHLY REPORT FORM

ORIENTATION MONTHLY REPORT

The District 5190 Rotary Youth Exchange Committee members are interested in your orientation progress. Each month you are required to fill out this form. The form is due on the last day on the month. Please be honest with your answers.

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.
Date
Name
Assigned Country
Country Counselor
Sponsoring Rotary Club
How Many times have you attended a Rotary Meeting or activity since your last report	Select from drop down box
How many hours a day are you spending learning your new language
List five new words that you have learned this month (in your host country language), and the meaning of each word	1. 2. 3. 4. 5.
What have you learned this month about your host country
What have you learned in the orientation that you feel will help you have a better exchange
What questions have you thought of since your last report