Monthly Host Family Report

Student understands and follows rules. *

	1	2	3	4
Poor					Excellent

Student's Participation in School/Community Activities. *

	1	2	3	4
Poor					Excellent

Student's academic performance. *

	1	2	3	4
Poor					Excellent

Student's overall conversational language abilities. *

	1	2	3	4
Poor					Excellent

Student's level of comfort and ease with Host Family. *

	1	2	3	4
Poor					Excellent

Student's interaction with the Host Family. *

	1	2	3	4
Poor					Excellent

Host family's interest/participation in student's personal welfare. *

	1	2	3	4
Poor					Excellent

Host family's interest/participation in student's education. *

	1	2	3	4
Poor					Excellent

Host family's interest/participation in student's extracurricular activities. *

	1	2	3	4
Poor					Excellent

Overall relationship between host family and student. *

	1	2	3	4
Poor					Excellent

Please provide any additional comments, particularly for ratings of 1 or 2 in any category. *
Feedback and Comments
Describe any academic challenges or improvements exhibited or expressed by the student. *
Give examples of the student's eating habits and/or mealtime interactions. *
How does the student spend his/her recreational time. *
Describe any other concerns or observations you have about your relationship with the student (if any). *
Were there any important events that took place in the student's life this month? *
Did the student miss any days of school this month? If so, how many days were they absent and what was the reason? *
How will you celebrate any upcoming holidays or events this month (ex. Halloween, Thanksgiving, New Year's, etc.)? *
Have you noticed anything significant, either academically or behaviorally, that you would like the student's natural parents to be aware of since last month's report (if applicable)? *
Please provide several pictures of the student so that we may share them with his/her parents.
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Monthly Evaluation 1 = Poor, 2 = Fair, 3 = Good, 4 = Excellent