CASA Volunteer Activities Form

Child/Case Name (#1):

Child/Case Name (#2):

Volunteer Name:

Report Month:

Date Submitted:

Activity Codes: 1 = Attended Foster Care Review 2 = Attended Hearing 3 = Attended Social Services Review 4 = Biological Parents Contacted 5 = CASA / GAL Supervisor Contacted 6 = Child Contacted Out of Court

7 = Collaterals Contacted 8 = Foster Parents Contacted 9 = Relatives Contacted 10 = Traveled 11 = Wrote Reports 12 = Other

Contact Codes: 1 = Face-to-Face 2 = E-Mail 3 = Phone 4 = Written 5 = Other

**IF YOU HAVE MORE THAN ONE CASE, PLEASE SIGNIFY WHICH ACTIVITY GOES WITH WHICH CASE.**

Child/Case Name:

Date of Activity:

Activity Code:

Contact Code:

Time Spent: (15 min intervals)

Miles Driven:

Out of Court? (Yes/No)

Notes: