Ask DOROT 212-769-2850



 
Donate


  

Not sure where to start?
There are a variety of ways to contact us.
We're always happy to help





Program of Distinction

UJA-New York


Package Delivery Feedback Form 2017

  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 us to his or her current needs.

  If you have any questions, please do not hesitate to contact us. We appreciate your help!

*

Name:

 

 

   

*

 

 

 

City/State/ZIP:

 

    

*

 


*


*
Question - Required - Location



*


*
Question - Required - I/We volunteered as a/an:



*


 

 
*


   


*  


   


   


*
Question - Required - Overall, how would you rate the visit?




 

(Maximum response 255 chars, approx. 5 rows of text)

 

 

 
  ADULTS ONLY (Not volunteers with children under the age of 18):
DOROT has a growing waiting list of lonely older adults hoping for ongoing visits.
 
Question - Not Required - Would you be interested in weekly visits with a senior on our waiting list:

 

 
 

Thank you for your comments and participation!


   Please leave this field empty

     

 
Powered By Blackbaud