Welcome to District 9600 Youth Exchange

Monthly Confidential Report

Report Date
Student Name
Sponsor Club
Host Club
District
Country
Host Counsellor Name
Counsellor Address
Counsellor Contact Details	Phone:(H): Phone:(W): Fax: E-mail:
Host Family Name
Host Family Address
Host Family Contact Details	Phone:(H): Phone:(W): Fax: E-mail:
* When you change host families, send details in the Change Of Address Form.
Do you have regular meetings with your counsellor?
How many Rotary meetings have you attended?

CONFIDENTIAL

Please tell us about any difficulties or problems you are having with families, clubs, school ect,

This information will be kept confidential

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