Cultural Homestay International - AYP Monthly Report

Cultural Homestay International - a non-profit educational exchange program

Before using this form, please check with your Area Administrator to see if she is set up to handle reports submitted by this method.

Month		Day		Month		Day	Year
MONTHLY ACADEMIC PROGRAM REPORT FOR		/		to		/		19

Student Code:		Host Family Code:
Student Name:		Host Family Name:
APA Name:		AC Name:

PLEASE RATE PROGRESS IN THE FOLLOWING AREAS:

	STUDENT'S OPINION
	1	½	2	½	3	½	4	½	5	1	½	2	½	3	½	4	½	5
A. Communication between the host family and student
B. Relationship between the host family and student
C. Following family guidelines
D. Student's participation in family responsibilities
E. Student's participation in school and/or community activities
F. Student's relationship with friends
G. Student's academic progress
H. Student's improvement in English conversation ability

Date AC spoke with student:		Date AC spoke with Host Parent:
		Mother Father

AC'S COMMENTS, SUGGESTIONS, AND/OR MESSAGES TO STUDENT'S PARENTS:
If 1 (Poor) or 2 (Needs Improvement) is checked as an answer to any of the questions above, please explain specifically the nature of the difficulty. Please include suggestions, ideas or solutions to the problem.

AC'S NAME: DATE:
AC'S E-MAIL ADDRESS:

Before submitting this report, have you selected the correct Area Administrator name at the top of this form?

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