Report Form · Rotary Club of Greensboro

Report Form for CWS Afghan Family

Please submit information regarding each contact you have the family that is being supported by the Rotary Club of Greensboro, or services that you provide for the family. If you have questions about the documentation, contact Pat Vreeland, our contact report coordinator. Email: patcvreeland@gmail.com Mobile: 336-706-5000 _________________________

Is this for the family that Greensboro Rotary is supporting?(Required)

Yes

No, it is for another family.

This form is to be used for the family being supported by Greensboro Rotary. If you are also supporting a different family, you need to report that through your contact with that family.

Name(Required)

First Last

Your Email(Required)

Your Phone Number(Required)

Date of Service(Required)

Amount of time spent volunteering(Required)

Use decimals and round to the nearest quarter hour. For example, .25, .5, 1.0, 1.25, etc.

Please enter a number greater than or equal to .15.

Travel time spent(Required)

Use decimals and round to the nearest quarter hour. For example, .25, .5, 1.0, 1.25, etc.

Please enter a number greater than or equal to 0.

Please list all clients who were present during the volunteer session you are recording.(Required)

Your hours count per person present. For example, if you volunteered two hours with X, Y, and their child Z, we are able to capture a total of 6 hours. Please let us know all participants at your meeting(s).

Number of miles driven(Required)

All miles driven to, during, and from volunteering.

Where was the service provided?(Required)

The client's home

Out in the community

Over the phone

Short explantion of services provided. Write in 3rd person.(Required)

Example: (Your Name) took (name of client) to the Dept of Social Services to apply for food stamps and Medicaid. He got the receipt and (your name) drove the client home. (Your name) left the (receipt/other paperwork/etc.) with the client and advised him to keep it in a safe place until he can share it with his Case Manager at their next meeting.

Items donated

Did you give the client anything? (e.g. money, groceries, household items, bicycles, electronics, etc.) If so, what item(s) and what was the value of the item(s) you donated?