Name of Volunteer :

Very helpful Somewhat helpful Not at all helpful

The most helpful thing the volunteer did or said was:

Something the volunteer did or said that was NOT helpful was:

COMMENTS I would like to convey to the Volunteer who helped me:

Were you given a copy of the Citizens Resource Guide?

Yes

Comments about the resource guide:

No I did not receive one. Please mail me one at the address below

Your Name:

Address:

City: State Zip Code

Day Phone: