Please update us on any address or phone number changes for you and your child.

1a. Your Email address

1b. Date

2. Youth(s) Case #

3a. Volunteer 1Vol #

4a. Are your phone number and E-mail address the same?Yes No (list new) 

5a. I will continue next month.Yes No (If no, please tell your child, the parent, and us goodbye.)

 6a. I anticipate graduating or resigning (date) 

3b. Volunteer 2Vol #

4b. Are your phone number and E-mail address the same?Yes No (list new) 

5b. I will continue next month.Yes No (If no, please tell your child, the parent, and us goodbye.)

 6b. I anticipate graduating or resigning. (date) 

7. This report represents a total of:

 a. # of Visits

 b. # of Hours

 c. Money Spent

 d. Miles Drive (approximate)

 e. # of Letters sent/Phone calls made/recd

 f. Do you need any help from us? Yes No

g. If yes, please explain. 

8. Please list by date, your activities with your child and comment on each one. Give us your views on how the relationship is progressing and how your child is doing.

<FONT SIZE=-1>Please list activities by date here. </FONT>

 
 

This page maintained by: Joyce A. Thomas-Vinson