Month of Service

Volunteer Name

Volunteer's E-mail

Child's Name

How many times did you see your "Little" this month?

Total hours spent with your "Little" this month?

If you have any questions, concerns or comments this month that would require a Big Brothers/Big Sisters case worker to contact you, please describe here:

Please report change of address, phone, employment or any other significant developments that are happening now:

If you prefer, you may print this form and mail to:
Joe Tarquinio
Family Services
5100 Peach Street
Erie, Pa 16509