Resident Council Meeting

Please complete this form if you have attended a resident council meeting. Send any questions or concerns to the Volunteer Coordinator.

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* 1. Volunteer Name

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* 2. Council President Name

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* 3. Facility Name:

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* 4. Travel Time

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* 5. How long were you at Council Meeting.

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* 6. Date of Meeting

Date / Time

Date

Time

AM/PM

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* 7. Total Attending

# Male-

# Female-

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* 8. Comments, Issues, are things being resolved each month?

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* 9. Highlight of the Meeting/ Recommendations

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* 10. Staff Presence

LNHA

Activities Director

Dietary Staff

Nursing Dept./ Support Staff

Other (please specify)

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* 11. Any concerns or questions regarding the council meeting?