Community Caregivers

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Report Time and Mileage

Thank you for reporting your volunteer time and mileage to Community Caregivers. We use these statistics for funding requests and reporting to grantors, so the information is essential to the ongoing success of our program. Please report your time and mileage monthly, or more often if you prefer.

To send the information to us electronically, complete the form below. Your report will be emailed directly to our office when you click on “Submit.” Note that you can use the “Tab” key to move from one input field to the next, or you can click in any field to begin entering information at that location.

If you’d like to use a paper form to record your time and mileage, download a printable form and then mail, fax or hand-deliver it to us at least monthly.

1) VISITATION
2) TRANSPORTATION (include library & prescription errands)
3) CAREGIVER'S RESPITE
4) SHOPPING
5) PHONE REASSURANCE
7) CHORES/REPAIRS
10) MEALS
11) HOUSEKEEPING
12) PAPERWORK
13) OFFICE & ADMINISTRATION (include time spent on CC meetings, projects, committees, etc.)

*required

Volunteer's Name	*
Volunteer's E-mail	* (required for processing)
Month	*
CLIENT A:
Date of Service:
Time Spent on Service
Mileage
Service Performed
Comments

CLIENT B:
Date of Service:
Time Spent on Service
Mileage
Service Performed
Comments

CLIENT C:
Date of Service:
Time Spent on Service
Mileage
Service Performed
Comments

CLIENT D:
Date of Service:
Time Spent on Service
Mileage
Service Performed
Comments

CLIENT E:
Date of Service:
Time Spent on Service
Mileage
Service Performed
Comments

CLIENT F:
Date of Service:
Time Spent on Service
Mileage
Service Performed
Comments
Please print this form for your records BEFORE hitting the “Submit” button

2021 Western Avenue, Suite 104, Albany, New York 12203 PH: 518.456.2898 info@CommunityCaregivers.org

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