Volunteer Time and Visit Summary

Thank you for committing your volunteer time to CICOA. Please complete all fields below. If you are experiencing issues please email volunteer@cicoa.org.

Volunteer Time and Visit Summary

"*" indicates required fields

Volunteer Name*

First Last

Client Name*

Select type of volunteer activity*

Date of Call*

Date of Visit*

Volunteer Time*

Please select the closest amount of time and include travel time if applicable. If you attempted to reach the client but could not connect, please select 15 minutes (or more if appropriate).

This field is hidden when viewing the form

Volunteer Time (hidden)

(Submit time in hours. Example: 15 minutes=0.25 hours. Please include travel time.)

Please enter a number greater than or equal to 0.

Please select if the following applies:

Client no longer wishes to be called.

Client's number is no longer valid.

Client is unable to take calls.

Client's caregiver would like to be called.

N/A

Please select if the following applies:

Client no longer wishes to be visited.

Client did not answer the door.

Client's caregiver would like to be called.

N/A

Visit Summary

If you left a message, you may indicate that here.

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Careers

Financials & Accountability

Contact Us

Senior Meals & Nutrition

Transportation

Caregiver Support

Online Request Form

Schedule an Appointment

Resource Finder

News & Stories

Events

Research

Referral Form

Incident Reporting

Become a Provider

Donate Now

Sponsor

Volunteer

Volunteer Time and Visit Summary

Volunteer Time and Visit Summary

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