MDF SGF Warmline Interaction Feedback Form

Dear MDF SGFs,

Thank you so much for your continued leadership! Your support is critical.

To better achieve the goals and objectives of the MDF Strategic Plan, please help us understand our community members' needs from time to time. The more we learn about our community's needs, the more responsive we can be in supporting them.

If your calls and emails with support group/community members outside the meeting space are information/resource related, please log them by filling out this form.

Any personal interactions that do not involve sharing of information or resources need not be logged using this form as they are considered personal/private conversations. An example of a personal interaction involves a check-in about each other's well-being without sharing any resources or information.

We greatly appreciate your time and effort in completing this form, so MDF may continue to learn and grow!

Question Title

* 1. Your Name:

Question Title

* 2. First name of the community member

Question Title

* 3. Last name of the community member

Question Title

* 4. Community member’s phone number: (Please respond to this section only if you have the relevant information)

Question Title

* 5. Community member’s email address: (Please respond to this section only if you have the relevant information)

Question Title

* 6. Community member's mailing address: (Please respond to this section only if you have the relevant information)

Question Title

* 7. Community member's relationship to DM

Question Title

* 8. Community member's topic of interest

Question Title

* 9. Method of communication with the community member

Question Title

* 10. Which of the following topic(s) were discussed in your conversation with the community member? Please select all topics that apply:

Question Title

* 11. Which of the following MDF resources did you share during your conversation with the community member? Please select all resources that apply.

Question Title

* 12. How much time did you spend interacting with the community member?

Question Title

* 13. Please summarize your conversation with the community member:

Question Title

* 14. Would you like MDF to reach out to the community member in a couple of weeks?

Question Title

* 15. Please let us know if there any specific topic(s) that MDF needs to follow up with the community member.

T