MA Money Management Program
Volunteer Monthly Report - Client Visitation
Volunteer Name
*
First Name
Last Name
Volunteer Email
*
(A summary of this report will be sent to this email address)
Date
*
-
Month
-
Day
Year
Date
Consumer Name
*
First Name
Last Name
Number of Consumer Visits
*
(How many visits does this report cover?)
Date(s) of Consumer Visits
*
(Please enter as MM/DD/YYYY and separate by commas)
Time Spent
*
(Total time spent over all visits covered by this report)
Does bank statement include check images? (If no, check register must be completed)
*
Yes
No
Is the ending bank balance below the MMP suggested limit of $5,000?
*
Yes
No
The MMP volunteer and the client met "in person" this month.
*
Yes
No
Volunteer service provided
*
Problems encountered
*
Comments
*
Mileage
Date of next visit
-
Month
-
Day
Year
Date
Receipts for cash obtained by volunteer
(if applicable, submit printed form)
Cash Receipts
Rows
Date
Check #
Amount
Cash Receipt 1
Cash Receipt 2
Check Register
Consumer's Name
First Name
Last Name
Last 4 digits of account number
Statement date (start date)
-
Month
-
Day
Year
Date
Statement date (end date)
-
Month
-
Day
Year
Date
Enter information for checks cleared during this statement period
Signature of volunteer
*
By typing your name here, you confirm that all information on this form is complete and correct.
Please verify that you are human
*
Submit
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