Report Hours

Thank you for your dedication and service to AVUS Connect® and United HomeCare®! Please use the form below to report your volunteer services hours. Please submit one form for each date.

Name *

First

Last

Phone number *

Email *

How did you volunteer?

• Office Volunteer
• Visited a client’s home
• Phone call or virtual meeting
• Tech Pals – Home Visit
• Tech Pals – Technical Education
• Tech Pals – Conversations
• Tech Pals – Caregiver Respite
• Tech Pals – Training
• Other

Enter date of volunteer service you are reporting, i.e. 6/10/2022: *

Enter number of hours completed and time frame, i.e. 1 hour, 2pm-3pm: *

If your service included any contact with a client, please write their name:

Please detail your volunteer service and experience specifically for the date entered above: *

Submit