Ambassador Contact Report Form

Please complete and submit this form after each event/contact with public. If you would like to submit a hard copy, you can download it here.
Please keep track of ALL the time you put into this (including preparation and travel) and report it. It's REALLY important! Thank you!


Note: all fields in this form are required. If there is a field that is not applicable to you or your event, please write N/A or something similar.

First and last name:

Date of event/contact:

Event/contact location and description:

Volunteer hours (including preparation time & travel:

Please estimate the number of people you talked to in the following categories:

20 years or under:

20-50 years of age:

50-70 years of age:

Over 70 years of age:

Please estimate the number of people who used wheelchairs:

Please estimate the number who were: M F

Please summarize questions asked that you need our help to answer:

Please summarize types of questions asked and significant comments, positive or negative:

Any names or information that could be helpful to State Committees:

Did the resources provided by the ECGA meet your needs for this event? If not, please feel free to make suggestions:

Any other comments?

Thank you!




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