^{THE RETIRED AND SENIOR VOLUNTEER PROGRAM}

^{RSVP of Lake County}

^{W-E Tech Center, 25 Public Square}

^{Willoughby, OH 44094 (440) 269-3015}

RECORD OF ATTENDANCE, MILEAGE & MEALS REPORT

Return this form no later than the 5^th of each month for the previous month

NAME MONTH .

VOLUNTEER STATION .

ASSIGNMENT DESCRIPTION	DATE	HOURS
TOTAL HOURS

VOLUNTEER SIGNATURE ________________________________________________

SUPERVISOR OR

PAID STAFF MEMBER’S SIGNATURE ________________________________________

Note: All forms must have the appropriate signatures before returning to the RSVP office.