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Your Name
Your Email Address*
Company Visited?
Who did you meet with?
What was his or her title?
Date of Visit
If applicable
Corporate Contribution Requested?
Contribution expected?
If corporate contribution not confirmed, what do we need to do for follow up?
Response to request receptive?
YES NO
Attitude toward United Way?
Campaign Coordinator's Name
Campaign Coordinator's Title
If Campaign Coordinator not confirmed, when do we need to call back?
Are group meetings a possibility?
Current number of employees:
Describe suggestions for employee campaign and the response to them:
Was a leadership or personal gift requested of CEO?
What was the response to this request?
Please describe the meeting for the benefit of the Loaned Executive follow-up and future volunteers calling on this account.
What is your overall reaction to the visit? The more information you can provide, the more successful we can be.
Please use this section to add any personal information about the CEO you may have gained from this visit.
