DMV Ambassador Program Post-Visit Summary Form Visit LogisticsVisit Date(Required) MM slash DD slash YYYY Office Name(Required)Arrival Time(Required) Hours : Minutes AM PM AM/PM Departure Time(Required) Hours : Minutes AM PM AM/PM List name(s) of Donation Professionals attending this visit(Required) Add RemoveOne name per line. Add additional line for each donation professional.List name(s) of Mission-Connected Ambassadors attending this visit(Required) Add RemoveOne name per line. Add additional line for each ambassador.Ambassador Did Not Attend Check here if any mission-connected ambassador scheduled for this visit did not attend for any reason Briefly explain reason mission‑connected ambassador(s) did not attend and when you learned they would be absent(Required)Engagement InformationHow DMV staff did you engage during this visit?(Required)Enter a number greater than “0.” Estimate if exact number is not known.Did any DMV staff share a mission connection during this visit?(Required) Yes No Explain briefly(Required)Were all materials listed on meeting guide checklist shared?(Required) Yes No What was not shared?(Required) Add RemoveOne item per line. Add line for each item.Were all topics on meeting guide checklist discussed?(Required) Yes No What was not discussed?(Required) Add RemoveOne item per line. Add line for each item.Office Needs and FeedbackAre there any Donate Life materials or signage needed?(Required)Consider if posters, brochures, and other public-facing materials are missing, low, damaged, or more are needed due to large office space Yes No List materials/signage needed.(Required) Add RemoveOne item per line. Add line for each item.Do we need to follow up with this office?(Required)For reasons other than replacing materials Yes No List item(s) needing follow-up.(Required) Add RemoveOne item per line. Add line for each item.Summarize the biggest takeaways from this visit (what’s going well, what’s challenging, etc.)?(Required)Upload ReceiptsWere any expenses for this visit charged to the Donate Life NYS company credit card?(Required) Yes No List expense(s) charged to Donate Life NYS company credit card(Required)Include one item per line. Add additional lines for each expense. Include expense type, vendor, and dollar amount i.e./ Refreshments – Dunkin Donuts – $25.00 Add RemoveAttach all receipts for purchases charged to Donate Life NYS' company credit card(Required) Drop files here or Select files Max. file size: 8 MB. Were there any out‑of‑pocket expenses for this visit that were not charged to the Donate Life NYS credit card and require reimbursement?(Required) Yes No List expense needing reimbursement(Required)Include one item per line. Add additional lines for each expense. Include expense type, vendor, and dollar amount i.e./ Food – Dunkin Donuts – $25.00 Add RemoveAttach all receipts and/or documentation for any items requiring reimbursement.(Required) Drop files here or Select files Max. file size: 8 MB. Upload PhotosAttach high quality photo(s) from your visit(Required) Drop files here or Select files Max. file size: 8 MB. No photos Check here if you do not have photos to share from this visit Explain briefly why there are no photos available to share from this visit(Required)CommentsUse this space to share any other relevant information, feedback, comments, etc.
