Passover Package Delivery Follow Up

	If you volunteered with children under the age of 18, please fill out the Family Package Delivery Feedback Form. Thank you for volunteering to deliver a package and visit with a senior. We hope this was a meaningful experience for you. Please fill out the form below including any pertinent information about the person you visited. Your comments alert DOROT to the current needs of this person.
	If you have any questions, please do not hesitate to contact us. We appreciate your help! * Name: First  Last      * Email: * Phone Number:   Keep me informed about upcoming events and developments at DOROT.
*	Older person visited:
*	Name of Program (choose one): Please select response Rosh Hashanah Package Delivery & 9/11 National Day of Service Thanksgiving Meal Delivery Chanukah Volunteer–One–Night Winter Package Delivery Purim Delivery Passover Package Delivery
	Senior's address:
	Length of visit:
*	Did you volunteer with a group? Please select response Yes No
	If yes, what is the name of the group:
*	Did you volunteer with other people? Please select response Yes No
	If yes, how many adults
	Name(s) of other visitor(s): (Maximum response 255 chars, approx. 5 rows of text)
*	Overall, how would you rate the visit? Excellent Good Fair Poor
	Did the person mention to you any areas in which he/she needs assistance?
	Did you notice anything that concerned you? (i.e., apartment condition, physical health, mood, etc.)
	Please use the following space to describe your visit (i.e., your reactions and general conversation topics):
	Would you be interested in visiting this person one hour a week? Please select response Yes No
	Would you be interested in visiting this person once a month? Please select response Yes No
	Comments: (Maximum response 255 chars, approx. 5 rows of text)
	Friendly Visiting: DOROT has a growing waiting list of seniors who are eager to be matched to a volunteer for weekly visits. Would you like to explore becoming a Friendly Visitor? Yes, please send me information.
*	Please rate how well the program was organized: Excellent Good Fair Poor
	What can we do to enhance the program? (Maximum response 255 chars, approx. 5 rows of text)
	If you participated in an orientation, did you find it helpful? Please select response Yes No
	Comments:
	Are you interested in volunteering with DOROT again? Please select response Yes No
	I am interested in the following Occasional Adult Volunteer Opportunities.
	Please contact me about: Homelessness Prevention Program (cook or host and serve meals at our facility) Help a senior shop for groceries Tutor a senior in computer use Accompany a senior to a cultural event and view exhibits, movie, (etc.) together Visit the home of a senior to cook and share a meal Receive email alerts from DOROT to assist seniors as needs arise (e.g. read to the visually impaired, run last minute errands, escort seniors, etc.)
	Other Comments or Suggestions:
	Thank you for your comments and participation!

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