Step 4:
Volunteer Tracking Form
(Please print a hard copy)
Touch The Future, Inc.
ReBoot & ATRC
Volunteer Tracking Form
Promoting Independence for People with Disabilities.
Volunteer's Name: _________________________________Date:___/___/___
This form is to be COMPLETED by the organization served and included with your application
Organization Served: _____________________________________________
Address: ______________________________________________________
City: _____________________ State: ____ Zip: ________
Phone: (_____)_____________________
E-Mail: ____________________________
Contact's Name: _________________________________________
Would you like to be on our mailing list? [ ] Yes [ ]No
Give a brief description of the organization's mission: ______________________________________________________________
______________________________________________________________
Give a description of the tasks performed by the ReBoot Volunteer: ______________________________________________________________
______________________________________________________________
Dates & Number of hours of service:
__/__/__ ____hours __/__/__ ____hours __/__/__ ____hours
__/__/__ ____hours __/__/__ ____hours __/__/__ ____hours
__/__/__ ____hours __/__/__ ____hours __/__/__ ____hours
Total Hours of Service_____
Signature _______________________________
Date:___________________________
Thank you for your time!
Joanne Willis, OTR/L
Touch the Future/ATRC Director
Phone: (770) 934-8432
Mail to: Touch The Future, Inc.
ReBoot & ATRC
Joanne Willis, OTR/L
4508 Bibb Boulevard, Suite B-10
Tucker, GA 30084