FBO Liaison Monthly Donation Report

Reporting Month*

Your Name*

Your Email*

Are you the FBO Liaison?
YesNo

FBO Name*

FBO Town*

Program Coordinator

If you would like your Program Coordinator to contact you, or if you would like to talk to an administrative staff person please let us know.
StaffAdministrative Staff

Type of Service/Donation	Quantity of Items	# of Children	Estimated Value
Collections and/or Special Projects






Specific Requests from Adopted Social Worker

If any of the following has changed since last month, please provide updated information.

Adopted Social Worker Name:

FBO leadership changes:

Contact Changes

Address

Other

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Directions

We have tried to make this form as simple as possible. Please do your best to complete all the items on the form. There are two types of services/donations to which your FBO community may have responded. Please complete both reporting sections. If there is no activity, simply note that in the appropriate section.

Collections and/or Special Projects

In your AASW Manual, you are given suggestions for seasonal and year round projects. You may have even designed your own unique project in partnership with your Social Worker and/or Program Coordinator. We ask that you report these project donations, e.g.:

Specific Requests from Adopted Social Worker

When your Adopted Social Worker makes a request for a specific child or family, for any
sort of item(s), we ask that you report how that request was filled, e.g.:

Value estimates are either actual cost of providing items, the individual donor’s estimate of value or your personal best guess at value. CCC does not assign the cash value of donations.