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Compeer Monthly Report
Please fill out this report and submit by the 5th of each month.
All information is confidential. Any questions, please e-mail us
at
staff@compeerbuffalo.org
*
Required Information Needed
Date of Report*
Month Reporting For*
Volunteer's Name*
Volunteer's E-mail Address*
Friend's First Name*
Hours Spent Visiting Your Friend*
Number of Visits*
Hours Spent on the Phone*
Describe activities which you and your friend(s) participated in this month
Do you have any concerns regarding your relationship with your friend due to your friend's condition?*
Do you need someone from Compeer to call you?
Home Phone Number*
Work Phone Number
(
)
-
The best time to call you
Has your address changed? If so, what is your new address?
Are there any changes to your friend's address, phone number or therapist?
Additional Comments or Questions
Do you feel your friend's mental health has improved because of your friendship?
Is this volunteer experience rewarding?
Program Coordinator's Name
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Compeer of Greater Buffalo 135 Delaware Avenue, Suite 210 Buffalo, New York 14202 716.883.3331 Fax: 716.883.3395
