Case Notes
Every interaction with newcomers must be captured. Please complete this short form so that we can continue to help refugee clients in the future.
Thank you!
Your name *
Your answer
First and Last name of client you were working with *
Your answer
Date of service *
Amount of time spent with client *
In 15 minute increments, INCLUDING TRAVEL TIME
Your answer
Number of miles driven *
All miles driven to, during, and from volunteering
Your answer
Where was the service provided? *
Did the interaction complete a CORE Service? *
A core service is a required service that must be completed in the R&P(Reception and Placement) period.
Please include a short description of your interaction with the client. *
Example: (Your name) took (name of client) to the Department of Social Services to apply for food stamps and Medicaid. He got the receipt and (your name) drove the client home. (Your name) left the (receipt/other paperwork/etc.) with the client and advised him to keep it in a safe place until he can share it with his Case Manager at their next meeting.
Your answer
Items donated *
Did you give the client anything? (e.g. money, groceries, clothing, household items, bicycles, electronics, etc.) If so, how many, and what was the value of the items you donated?
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service