National Data
Please use most current information over the last 12 months to complete this survey
Name of Volunteer Caregiving Organization
*
Year Volunteer Caregiving Organization was Established
Address
*
Street Address
City
State / Province
Postal / Zip Code
Directors Name
*
First Name
Last Name
Directors Phone Number
*
Please enter a valid phone number.
Directors Email
*
example@example.com
How many FULL Time paid office staff do you have?
How many PART Time paid office staff do you have?
How many UNPAID interns do you have?
How many UNPAID volunteers do you have working in the office?
What is your annual budget?
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Please use most current information over the last 12 months to complete this survey
Which of these types of services do you offer?
*
Companionship
Transportation
Phone Friends
Shopping
Respite
Dementia Respite
Housekeeping
Yardwork
Economic Solutions
Managing Assets for Security and Health (MASH)
Hospital to Home
Meal Prep
Mail/Paperwork
Pet Care
Other
Person Served
Total number of Person Served
What types of people do you serve?
Residence of Long Term Care
Adults Aging in Place
Persons with Disabilities
Hospice
HIV/Aids
Under 60
60 and Over
Volunteer
Total Number of Volunteers
What are the total volunteer hours?
What are the total volunteer miles?
What are the total volunteer trips?
What are the age ranges of your Volunteers?
17 and Under
18-24
25-44
45-64
65+
How many Congregations does your organization work with?
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Detailed Person Served
Please use most current information over the last 12 months to complete this survey
% of persons served who are Male
% of persons served who are Female
Person Served Ethnicity
Please identify below the % Person Served ethnicity
% of persons served who are Asian
% of persons served who are Black or African American
% of persons served who are White
% of persons served who are Hispanic or Latino
% of persons served who are Native Hawaiian or Other Pacific Islander
% of persons served who are American Indian or Alaska Native
% of persons served who are Veteran
% of persons served who are LGBT+
% of persons served who are Functionally Impaired
% of persons served who are Dementia Diagnosis
% of Person Served who are Living Alone
Person Served Income
Based on your state federal standards
% of Person Served who are Extremely Low Income
% of Person Served who are Very Low Income
% of Person Served who are Low Income
% of Person Served who are Non-Low/Moderate Income
% of Person Served who are Medicaid Eligible
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Volunteers
Please use most current information over the last 12 months to complete this survey
% of Volunteers who are Male
% of Volunteers who are Female
Volunteer Ethnicity
Please identify below the % volunteers ethnicity
% of Volunteers who are Asian
% of Volunteers who are Black or African American
% of Volunteers who are White
% of Volunteers who are Hispanic or Latino
% of Volunteers who are Native Hawaiian or Other Pacific Islander
% of Volunteers who are American Indian or Alaska Native
% of Volunteers who are Veterans
Volunteer Ages
Please identify below the % of volunteers ages
% of Volunteers who are 17 and Under
% of Volunteers who are 18-24
% of Volunteers who are 25-44
% of Volunteers who are 45-64
% of Volunteers who are 65 and Over
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Faith in Action
What percentage of your combined Person Served and Volunteers identify as these religions? Please use most current information over the last 12 months to complete this survey
% of Person Served and Volunteers who areJewish
% of Person Served and Volunteers who are Buddhist
% of Person Served and Volunteers who are Christian/Protestant
% of Person Served and Volunteers who are Christian/Catholic
% of Person Served and Volunteers who are Christian/Mormon
% of Person Served and Volunteers who are Christian/Jehovah's Witness
% of Person Served and Volunteers who are Christian/Orthodox
% of Person Served and Volunteers who are Christian/Other
% of Person Served and Volunteers who are Christian/Unspecified
% of Person Served and Volunteers who are Hindu
% of Person Served and Volunteers who are Muslim
% of Person Served and Volunteers who are Other Faith
% of Person Served and Volunteers who are Unaffiliated
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Funding
Please use most current information over the last 12 months to complete this survey Please Identify below the percentage of where your funding comes from:
% of funding from Foundations
% of funding from Corporations
% of funding from Individuals
% of funding from Government
% of funding from Congregations
% of funding from Fundraising Events
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Geographic Footprint
Please use most current information over the last 12 months to complete this survey
The Number of Counties Served
1
2
3
4
5
6 or More
Identify the names of each county served. (*Please also send a Zip Code list to kaylin@nvcnetwork.org)
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Should be Empty: