designed by lukas boruta copyright 2008 ICEO Inc. 
 
 

12-month Work & Travel Pilot Program 60-day Progress Report

Participant Information
 
DS 2019 #:
Social Security #:
Last Name:
First Name:
Middle:
Country of Citizenship:
Date of Birth (month/day/year):

US Home Mailing Address
Address:
City:
State:
Zip Code:
Country:
Telephone:
Email:
Employer Information
 
Employer Name:
Employer Address:
City:
State:
Zip Code:
Name of Supervisor:
Title:
Telephone:
Fax:
Email:
Employment
 
1. Current employer start date (month/day/year):

Please rate the following, thus far in your program on a scale of 1-4
(1 - poor, 2 - average, 3 - good, 4 - excellent)
2. Your cooperation with your employer:
1 2 3 4
3. Your employment location:
1 2 3 4
4. Your job:
1 2 3 4
5. Approximately, how many hours per week did you work in the last 60 days?
6. Are you satisfied with your job?
yes no
7. What is your current position?
8. If you aren’t satisfied with your job, what would you change about it?
Program Services
 
Please rate the following on a scale of 1-4
(1 - poor, 2 - average, 3 - good, 4 - excellent)
9. Post-Arrival Orientation (only needed for the first report):
1 2 3 4
10. ICEO’s headquarter services:
1 2 3 4
11. ICEO’s regional representative’s assistance:
1 2 3 4
12. Emergency assistance (if applicable):
1 2 3 4
13. Please list the new skills and abilities you have acquired during this portion of your program:
14. Please list the cultural activities you have taken part in during this portion of your program:
15. Comments: