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

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This field is for validation purposes and should be left unchanged.

Volunteer Name(Required)

First Last

Select type of volunteer activity(Required)

Date of Activity(Required)

Volunteer Time(Required)

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).

Volunteer Activity Summary

Briefly describe what you did. If you have any highlights or feedback to share with the volunteer coordinators, please let us know!

Senior Buddies

Please only fill out these questions if you are a volunteer for the Senior Buddies program.

Client Name

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Client's number is no longer valid.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

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Date of Visit(Required)

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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.

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Volunteer Time and Visit Summary

Volunteer Time and Visit Summary

Senior Buddies