Please report on your senior liaison outreach activities.

Name

First Name

Last Name

Senior Center or Housing Complex

Contact at senior center or housing complex (name and email/phone)

Log actions taken at the center

Please check the actions you are reporting on. Please use the comments box below to provide any further details you think would be helpful.

Contact identified

Brochures placed

Poster visible

Newsletter article published

Voter registration session held

Voter Photo ID presentation made

Candidates' Answers delivered

Rides to DMV arranged

Other

Date of activity

MM

DD

YYYY

Comments