Volunteer Mileage Reporting Form

Report Time and Mileage

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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 sent directly to our office when you click on “Submit.” You may download our Volunteer Service Report Form (PDF) and which you can then mail, fax or hand-deliver it to us at least monthly.

Be sure to include:

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

Volunteer Mileage Reporting Form


Fields marked with * are required.

Your name:*
Your e-mail:*
Month

Client A:

Client A name:
Client A date of service:
Client A time spent on service:
Client A mileage:
Client A service performed:
Client A comments:

Client B:

Client B name:
Client B date of service:
Client B time spent on service:
Client B mileage:
Client B service performed:
Client B comments:

Client C:

Client C name:
Client C date of service:
Client C time spent on service:
Client C mileage:
Client C service performed:
Client C comments:

Client D:

Client D name:
Client D date of service:
Client D time spent on service:
Client D mileage:
Client D service performed:
Client D comments:

Client E:

Client E name:
Client E date of service:
Client E time spent on service:
Client E mileage:
Client E service performed:
Client E comments:

Client F:

Client F name:
Client F date of service:
Client F time spent on service:
Client F mileage:
Client F service performed:
Client F comments:

Please print this form for your records BEFORE clicking the Submit button.

Type the characters you see here: