Nacel Open Door

MONTHLY CONTACT REPORT FORM

Monthly reports are to be completed and submitted by the 25th of EACH month.
Reports will be sent to the county director each month.

Reporting Month

Student’s Arrival Month

August January

Program Duration

5 Month 10 Month 12 Month

Student's Name

Student's Country

Host Family

City and State

Area Representative Name

Coordinator Name

PARENT QUESTIONS

Date of Conversation

Does host parent have privacy to speak openly?

1. How well is your student communicating, doing chores, participating in family activities, etc?

2. Please tell me about any special achievements, setbacks, or special considerations this month.

3. How is your student doing in school? Are his or her English skills improving?

4. How often does your student call or email family and friends?

5. Do you have any questions for me (travel, insurance, temporary housing, etc.)? Are there any problems I can help with?

6. Has there been anyone 18 years of age or older who has been or is staying in your house overnight?

7. On a scale of 1-10 (1=poor, 10=excellent) how would you rate your experience with this student?

STUDENT QUESTIONS

Date of Conversation

Does student have privacy to speak openly?

1. Tell me about your relationship with your host parents and siblings (excellent, good, fair, poor, etc.?).

2. How well are you communicating with your host family, doing chores, and participating in family activities?

3. List your grades in each subject.

4. Tell me about your friends, classes, sporting groups, etc.

5. Do you have any questions or problems I can help you with at school or in the host home?

6. Tell me about the best thing that happened in the host home and at school this month?

7. How often do you call or e-mail your family and friends?

8. Has anything happened in your host family home that has made you uncomfortable?

9. On a scale of 1-10, how would you rate your experience with this Host Family?

REPRESENTATIVE COMMENTS & EVALUATION

Please note any issues with the Student, Host Family, et cetera which might not have been addressed above, and/or provide explanation of what is being done locally to resolve any issue which is raised above.

IMPORTANT NOTE

Please enter your e-mail address below if you want a copy of this form sent to you for your own records.

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