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Action at Home Project Report

This form is to be completed by all volunteers following the completion of their action at home.

1. Volunteer name: 2. ICS agency:

3. Country of placement: 4. Location of placement (town or


region):

5. Month & year placement started: 6. Month & year placement ended:

7. [ ] UK volunteer [ ] In-Country volunteer 8. Date and Address of Action at Home done:

8: Where was your action at home held (please give town or district, and country):

9. Please select the sector addressed by the social action. Choose one sector your social action most focused
on:

 Education
 Health
 Livelihoods
 Sexual and Reproductive Health
 Strengthening Civil Society
 Environment
 Other ( Specify )
If other please lists the sector here:

10. What were the aims of your social action?

To raise awareness of an issue of

• To encourage others to volunteer

• To change people’s behaviour

• To involve others in taking action

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• To raise funds for a project

• To create a link between individuals/organizations in the UK and another country

• Other

If other please lists your aims here:

11. Please describe in brief your social action. Tell us what you planned to do, what actually happened and
what was achieved:

12. How many people attended/were engaged with your action:

13. Did any community leaders or officials attend your action (e.g. politicians, local government officials)?

Yes No

If yes, please give details of who attended, and their position:

14. Did your action receive any media coverage? Yes No

If yes, please give the name of the newspaper, radio station or TV station, or a link to the social media site:

If you used social media how many hits/likes did you receive?

15. How would you estimate the success of your action?

Very Not Not at all


Successful (2) Neutral (3)
successful (1) successful (4) successful (5)
    

16. Please provide a quote from someone attending the action describing what they learnt or what they intend
to do as a result of your action:

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17. Do you plan to continue volunteering at home or have future plans to expand on their social action? If yes,
please give details of your plans here:

18. Do you have any further comments or reflections on your social action?

Annexes: Please attach action oriented pictures and attendance sheet*

Thank you for completing the Action at Home Project report

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