Community Service Survey
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COMMUNITY SERVICE SURVEY

 

TO ALL PASR MEMBERS: Thank you for being a volunteer in our community!

 

PASR CHAPTERS are interested in documenting the hours of service that volunteer retirees contribute to their local communities.  In doing this, our volunteers show to the community at large a positive picture of the activities of public school retirees.  Please take a moment to complete the chart below, filling in the appropriate number of hours PER YEAR which you volunteer.  A summary of this information will be shared with AARP, NRTA and the state PASR.

 

EDUCATIONAL                    HRS/YR 
Historical Assn  ...............                   
Library  ............................                   
School Board ...................                   
Other ...............................                   
     Total  ..........................                   
 
SOCIAL SERVICES             HRS/YR 
Boards/Committees..........                  
Cancer Society..................                  
Drug/Alcohol.....................                  
Fire/Ambulance ................                 
Fraternal Groups ..............                 
Hospital/Nursing Home.....                 
Meals on Wheels ..............                 
Office of the Aging.............                
Red Cross ..........................                
Salvation Army   ................                 
Service Organization .........                 
Soup Kitchen/Food Bank...                 
Visitation/Nursing ..............                 
Other ..................................                 
     Total  .............................                         

  POLITICAL                          HRS/YR 
Advocacy  ..........................                 
Elections............................                 
Government........................                
Other ..................................                
     Total  ............................                 
 
RELIGIOUS                          HRS/YR 
Adult Instruction ................                
Youth Instruction ................               
Organization ........................               
Visitation...............................             
Other   ..................................             
     Total  ................................               
 
 
            
SERVICES TO YOUTH        HRS/YR 
Alliance with Youth..........                   
Classroon Volunteer..........                 
Head Start  ........................                 
Latch-Key Program ..............            
Literacy  ...............................             
Scholarships .........................              
School Volunteer ..................              
Sports....................................              
Tutoring ................................              
YM/YWCA ............................             
Other ..................................                
     Total  ................................               

TOTAL HRS/YEAR
ALL CATEGORIES:  ___________________
 
PHONE NUNBER: _____________________
 
NAME:________________________________
 

 
CHAPTER:  ___________________
 
DATE:  _______________________
 
E-MAIL: ______________________

I HAVE SERVED IN SPECIAL LEADERSHIP ROLES AS FOLLOWS:
 
______________________________________________________________________________________________________________________________________________
 
 
____________________________________________________________________________________________________________________________________
 
 

Return this form to:

Warren Steigerwalt, 8 Cold Spring Rd., Andreas, PA 18211

 

Please use the back of this form for clarification or description of your involvement with activities that are not listed.

 

Form revised as of October 2005.