HELPLINE CALLER FORM
Advocate/Volunteer
*
Date
*
/
Month
/
Day
Year
Date
Time
*
Length of Call
*
Name of Caller
*
Cell Phone
*
Format: (000) 000-0000.
Is it safe to call you?
Yes
No
Is it safe to leave a voicemail?
Yes
No
AMAC?
*
Yes
No
TYPE OF CALL
*
DV
SA
ST
INFO
SERVICE BLEND
Reason for Calling:
*
Resources Given By Advocate/Volunteer:
*
Shelter Screening?
*
Yes
No
Crisis call?
*
Crisis Call
Non Crisis Call
*A legal referral to another agency will be given by SARC Legal Staff only.
Submit
Should be Empty: