SVdP Neighbor Contact TeamWeekly Report Form

Monthly reporting form for neighbor contact teams

Team number*
- Team 1
- Team 2
- Team 3
- Team 4
Select one
Service end date*
Date Format: MM slash DD slash YYYY

This is your last day of service and should be a Sunday date.
Number of visits (preceding month)*
In the preceding month (including the week just
past), how many home visits were made?
Number of households*
How many individual households were aided, either with physical assistance or other assistance?
Number of adults assisted*
How many adults reside in those households receiving assistance?
Number of children assisted*
How many children reside in those households receiving assistance?
Expenditures*
Including gift cards, what is the total dollar
value of the assistance that was given?
Hours spent*
Please enter a number greater than or equal to 56.
How many hours were spent,
including time spent monitoring the phone
Miles driven*
How many miles were driven during the course of delivering assistance; include miles to/from food pantry
Your email*

Please enter your email address above