J-! Secondary School Student Program Check-In

11/16/2020

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J-1 Secondary School Student Program Check-In

The Department of State oversees the Secondary School Student Program (SSSP) and its administration
by the sponsor organizations. Please use this survey to provide us with a quick summary of your SSSP
exchange experience so far. Your answers will be combined with information from other exchange
students to ensure your health, safety, and welfare and used by the Department of State to improve the
program for current and future participants.
Your responses will be anonymous for the purposes of reporting. The only instances when your name may
be used are for the purpose of follow-up on specific problems identified in this survey. The Department of
State works with exchange students when they have serious concerns about their programs and their
sponsor is unwilling or unable to assist them. If you would like our help, please provide your contact
information when prompted at the end of the survey. Note that we will also ask whether you know of any
other students having difficulties that might require follow-up by the Department of State. If you supply the
names of other students and the Department of State follows up, your name will not be linked to these
referrals.
Your participation in this survey is voluntary, and you are free to choose not to answer any question. You are
under no obligation to supply your own name or the names of other students having difficulties.
We appreciate your help and hope that you have a great rest of your program! If you have any questions or
issues with the form, please send an email to [email protected].

Yes - enter the survey
No - exit the survey

Please select your sponsor organization from the list below.

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When did you arrive on program (mm-dd-yyyy)?

Did you have to quarantine or take any other precautions as a result of the COVID-19 pandemic?

Yes, I had to quarantine in my host family’s home before starting school.
Yes, I had to...
No

Have you been attending in-person classes at your school since starting school?

Yes
No, my school only has in-person classes part of the time (virtual rest of the time).
No, my school has closed and been 100% virtual for some part of the school year.
No, my school has always been virtual since I arrived on program.
Other (please describe)

Do you feel safe in your host family, school, and community?

Always
Most of the time
Sometimes
Never

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How would you rate your exchange experience so far?

Extremely good

Somewhat good

Neither good nor
bad

Somewhat bad

Extremely bad

Has your Local Coordinator or Representative been checking in with you each month?

Yes
No
Checks in, but less often than once per month.

If so, how does he/she normally check-in? (check all that apply)

In-Person
Video Chat
Phone Calls
Texts
Social Media
Other (please describe)

Have you had to change host families?

Yes
No

Was the change a result of normal Rotary procedures?
Yes
No
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Please describe the reason for changing host families.

How would you rate your experience with your host family(ies)?

Extremely good

Somewhat good

Neither good nor
bad

Somewhat bad

Extremely bad

Do you have any other concerns about your program that you would like to share? If so, please describe.

Would you like the Department of State to follow up on the concern(s) you have identified? If so, please enter your name and
email address below. (You are do not have to give your name.)

Name

Email Address

Do you have any concerns about the experiences of another exchange student? If so, please provide the individual's
name, email address, and a brief description of the issue. The Department of State will follow up without linking your
name to the referral. (You are do not have to give a name here.)
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Name

Email Address

Description of issue

Thank you for taking our survey. Your response is very important to us.
Exchange Visitor Program
Emergency Hotline: 24/7 toll-free telephone number: 1-866-283-9090
Email/General Inquires: [email protected]
Regulations: J-1 Visa Program
Website: http://j1visa.state.gov

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