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Eisner Prize Winner

Program of Distinction

UJA-New York


Response Team Feedback Form 2018

  Thank you for volunteering. Please fill out the form below including any pertinent information about the person you assisted today. Your comments alert DOROT to the current needs of this person.

  Your information:

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Name:

 

 

   

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Question - Required - Date that you assisted this senior:




* Length of time volunteer spent on phone with senior (aide, etc.) to arrange opportunity:
(Select one of the available choices or enter a different value.)



* Length of visit/volunteer opportunity (Includes time spent traveling with senior if applicable). Approximately:
(Select one of the available choices or enter a different value.)



 
Question - Not Required - What type of assistance did you provide?





 
Question - Not Required - Please specify the type of assistance provided

   


   


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Question - Not Required - If applicable, please check one of the following:




 

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Question - Required - Overall, how would you rate your volunteer experience?




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  After you click ‘Submit’, you will receive an email confirming submission of your form. If you do not receive this email, please email Rachel McGivern at rmcgivern@dorotusa.org to follow up.
   Please leave this field empty

     

 
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