Natural Helpers Online Contact Reporting

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Personal Information


My contact information has changed

Information on Person Contacted

Who did you speak with? *


How many people did you talk with during this conversation?  

What country was this contact from? (for everyone you problem-solved with in this contact)

What zip code does this contact/do these contacts live in?

What gender is the contact? If you talked to a male and a female, select both.
Female
Male

Approximately how old is this contact?
(NOTE: The person you contacted with may not be the same as the person needing help.)

Background Information About the Conversation

In what kind of environment did this conversation take place?

In what zip code did this conversation take place?
If this took place on the telephone, list zip code of where the person is calling from.


Who needed the help?

Using your best guess, how many families were you trying to directly help during this contact?

How much time did you spend together during this contact time?

The Conversation Itself

Roughly how many topics did you discuss in the conversation?

Describe the person/people who needed the help (this might not be the person you talked to.)

In what general areas did the person you were talking with want assistance? Check all that apply.
Accidents/Fires
Banking/financial/wiring/saving/financial literacy
Basic Needs Beyond Food (Clothing, furniture, baby supplies)
Bureau of Motor Vehicles
Business Ownership (training, loans, technical help)
Education
Children/Child development
Food and Nutrition
Government Agencies/services (working with, accessing, understanding)
Health-Related (Mental/Physical)
Housing-related
Immigration Issues
Income/Job/Vocation/Taxes
Insurance
Language
Legal (lawyer, advocate, laws, rights of any kind)
Refugee Support (initial, mental health, upheaval, devastation, other than basic needs)
Safety/Crime/Mediation (personal/other than immigration status)
Socializing, Community, Entertainment
Spiritual
Transportation (public, purchasing)
Other


Which, if any, of the following skills did you use during the actual time of this contact?
Translation
Advocacy (on someone’s behalf)
Listening/Encouraging
Connecting with a specific resource with or for my contact
Providing information, but no referral
Mediating between two or more people
Teaching
Emergency (immediate need, immediate fix)
Emotional Support, encouragement


How would you describe what you provided at the time of this contact?

What's Next?

Now that this conversation has ended, what will you do next?

Even if you will not stay in touch regarding this conversation, does this person seem to need help with more issues than you discussed or helped with during this contact?

Personally, I Need Help With:
Nothing right now
Helping contacts feel more comfortable talking to me
Finding referrals that actually work or that are the right referral for the issue
Teaching my contacts how to be assertive with referral source
Setting limits with my contact
Keeping things organized
Other

Other Information

New referral source you've learned about


Comments or problems you want to report about places you’ve sent any contact to

Have a story of success or difficult situation you want IWC staff to know?
(This can be about the contact in this report or a contact from another report.)

Security Code

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