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Monthly Activity Report
Volunteer Monthly Activity Report
* required fields
Volunteer's name:
*
Month of:
*
Year:
*
Name of CanCare Referral
# of Visits:
# of Calls, Cards/Emails
# of Hours
Contact Has Ended***
(permananet end date)
***Giving a permanent end date for a referral means: that you do not plan to visit, call or contact the referral about matters pertaining to their cancer. In other words, they no longer need you as a volunteer and in support of their illness.
Non-CanCare Referrals/Contacts
No Names Required
# of People
# of Visits
# of Calls
# of Hours
If any of these persons would like to be your official
CanCare referrals please provide information in the
section below.
New Referral Contact Information
(name, birthdate, address, telephone number, cancer type, date of diagnosis and any treatments, if available)
Additional Comments
Check here to confirm your report
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© Copyright 2010, CanCare, Inc.
9575 Katy Freeway, Suite 428, Houston, Texas 77024
713.461.0028 or 1.888.461.0028, Fax 713.461.0704
CanCare, Inc. is a nonprofit 501(c)(3) organization.