Community and Institutional Services Log Sheet

COMMUNITY AND INSTITUTIONAL SERVICES LOG SHEET 10/10

Date of Presentation:____/____/____ / Total # of Presentations:_____ / Total Presentation Hrs:______/ Number Of Participants:______/ Number of Staff:______
Staff Name / Conduct Hours / Preparation Hours / Travel Hours
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Agency:______/ Location:______/ County:______

TYPE OF SERVICE/PRESENTATION PROVIDED

Institutional Advocacy: / Professional Training / Public Education: / School Presentations: / In-House Training: / Other Activities: / Publications
q  Med./Hospital / q  Med./Hospital / q  Youth Org. / q  Preschool / q  New Volunteer / q  DV Court Orientation (non clients) / q  TV
q  Law Enforcement / q  Law Enforcement/CJ / q  Religious Org. / q  Kindergarten / q  In-service Volunteer / q  Board Activities / q  Radio
q  Judge / q  State’s Attorney / q  Civic Org. / q  Primary / q  New Staff / q  Non-Direct Service Volunteer Activity / q  Print Media
q  Soc. Service / q  Judge / q  Employees/Employers / q  Junior High / q  In-Service Staff / q  Staff Consultation
q  Teacher/Educator / q  Soc. Service / q  Other Client Groups / q  High School
q  Other: / q  Teacher/Educator / q  Other: / q  Post Secondary
q  Clergy
q  Other:

Comments:______