Outbound Report

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
Host Country
Host Rotary Club
RELATIONSHIPS We are interested in knowing what you feel about your relationships
Your Host Rotary Club	Select from drop down box
Your Rotary Counselor	Select from drop down box
Your Host Family	Select from drop down box
Your School Friends	Select from drop down box
Your Teachers	Select from drop down box
Write any comments that you have about your relationships
ROTARY
How Many times have you attended a Rotary Meeting or activity since your last report	Select from drop down box
Since your last report, how many times have you been invited to dinner, or other activities by club members other than your host family	Select from drop down box
Since your last report, have you attended any Rotary District Activities	Select from drop down box
Have you spoken to your Rotary Club	Select from drop down box
Have you written to your Sponsoring Rotary club this month	Select from drop down box
HOST ROTARY CLUB COUNSELOR
Name of Counselor
How often do you meet with your Counselor	Select from drop down box
Who takes the initiative	Select from drop down box
Do you receive your Rotary allowance each month	Select from drop down box
How Much in US$
SCHOOL
What Classes are you taking
What school activities are you participating in
What do you like best about school
Any school problems
YOUR THOUGHTS & COMMENTS
What has been your happiest experience since your last report
How do you feel about your exchange at the present time
Any other comments you would like to make, either positive or negative