Evaluation Form

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Your feedback is very important to us. The information gathered on this form is used to evaluate how our volunteer(s) did in assisting you. Please take a few moments to complete the form below.

Your Information

First Name

Last Name

Email

Phone

Incident Information

The below information can be found on the letter you received in the mail.

If you did not receive a letter and do not have the information below, please leave blank.

Volunteer(s) Name

Reference Number

Incident Date

Feedback

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I really liked that my TIP volunteer(s)...

I would have liked if my TIP volunteer(s)...

I would like TIP to know...

Did you receive a Community Resource Guide?

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No

Comments on Community Resource Guide

Additional Information

Please check anything you would like more information on...

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Donation (optional)

Our services are provided free-of-charge; however, many individuals have asked how to support our organization. If you wish to do so, you may make a donation by using the form below. Please allow up to 72 hours for your donation to be processed.

Name on Card

Billing Address (Include City/State/Zip Code)

Card Number

Expiration Date

Security Code

Donation Amount

Phone

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Email for Donation Acknowledgement

Thank you! Your evaluation has been submitted.

The Trauma Intervention Program (TIP) of Southern Nevada, Inc., is a tax-exempt organization under section 501(c)(3) of the Internal Revenue Code. The Federal Tax Identification Number (EIN) is 26-2603806. Your contribution may qualify as a federally recognized tax deduction.

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