GUARDIANSHIP PROGRAM

MONEY MANAGEMENT - TIME AND MILEAGE CONTACT LOG

MONTH / YEAR

(Use tab to navigate from field to field - the enter button acts as submit and should be used only when form is completely filled in.)

CLIENT NAME:	VOLUNTEER NAME:
	PERSON TYPE OF PHONE NO. PURPOSE OF CONTACT CASE
:DATE	CONTACTED CONTACT SUMMARY TIME** MILES












		TOTALS - MINUTES MILES
	*Key V= Face-to-face visit with client P= Phone call O= Other S= Support/Training	**ENTER IN MINUTES (EXAMPLE 2 HOURS = 120)

MONTHLY SUMMARY

STATUS OF CLIENT

DATES OF VISITS:

The current status of my client is:

Stable

Significant Improvement

Significant Deterioration

Immediate Attention by GSI

Other

Comments/Problems:

REIMBURSEMENT

Do you want reimbursement for mileage & other expenses? YES: NO:

If so, please complete the mileage column and list any other expenses below.

Other expenses: (postage, copying, parking, etc.) $

Total $

Reimbursement requests must be received on the 4th day of the month in order to be compensated.