ANNUAL SURVEY OF FRATERNAL ACTIVITY FOR TWELVE MONTH PERIOD ENDING DECEMBER 31, 2011 20___ S Circle Number ___________________ Location ____________________________________ city/town
I.I. NUMBER MEETINGS HELD DURING YEAR:YEAR: OF MEETINGS HELD DURING NUMBEROF MEETINGS HELD DURING YEAR: 1. 1. 2. 2. 3. 3.
Youth Activities Youth Activities
Regular Regular Social Social Special Special
TOTAL NUMBER OF MEETINGS HELD TOTAL NUMBER OF MEETINGS HELD II. ACTIVITY EXPENSE II. ACTIVITY EXPENSE 1. a. Printing and Postage b. Printing Food and Refreshments 1. a. and Postage c. Prizes b. Food and Refreshments d. Projects c. Prizes e. Entertainment d. f. Projects Miscellaneous e. Entertainment f. Miscellaneous TOTAL ACTIVITY EXPENSES
III. TOTAL CHARITABLE : III. CHARITABLE DISBURSEMENTS: ACTIVITYDISBURSEMENTS: EXPENSES Church Activities 1. a. Church Facilities III. CHARITABLE DISBURSEMENTS:
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Total Pro-Life Disbursements Total Pro-Life Disbursements
DOLLARS ONLY:
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Columbian Squires 4. a. Columbian Squires Scouting b. Scouting Youth c. Groups Youth Groups Youth d. Welfare/Services Youth Welfare/Services e. Athletics Athletics f. Scholarships/Education Scholarships/Education g. Miscellaneous Miscellaneous
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IV. COMMITMENT: IV. FRATERNAL FRATERNAL COMMITMENT: IV. FRATERNAL COMMITMENT: 1. Number of visits to: 1. Numbera.of Sick visits to: a. Sickb. Bereaved b. Bereaved
Total Visits Total Visits
b. Catholic Schools
d. Seminarians/RSVP 1. a. Facilities e. Church Seminaries b. Schools f. Catholic Vocations Projects g. Religious Miscellaneous c. Education d. Seminarians/RSVP Total Church Disbursements e. Seminaries f. Vocations Projects Community Activities g. Miscellaneous 2. a. Elderly b. Physically Disabled Total ChurchOlympics Disbursements c. Special d. Intellectual Disabilities e. Human Activities Needs Community f. Victims of Disasters 2. a. g. Elderly Hospitals/Institutions h. Physically Health and Service Organizations b. Disabled Projects i. Special Community–wide c. Olympics j. Habitat for Humanity Projects d. Citizens with Intellectual Disabilities k: Miscellaneous e. Human Needs f. Pro-Life Programs Disbursements Total Community g. Victims of Disasters h. Hospitals/Institutions Pro-Life Activities i. Health and Service Organizations 3. a. Donations j. Community wide Projects b. Hall usage k. for Humanity c. Habitat Birthright l.d. Miscellaneous Baby showers e. Baby bottle campaign f. Memorials to unborn children Total Community Disbursements g. Ultra-sound program
3. a. b. c. d. e. f. g.
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Church Activities c. Religious Education
state/province
2. Number of blood donors 3. Habitat Humanity Projects 2. Number of bloodfor donors 3. Habitat for Humanity
Estimated hours of volunteer service: Estimated hours of volunteer service: 4. a. Church b. Community Church c. Youth Community d. Habitat for Humanity Youth e: Miscellaneous Habitat for Humanity Miscellaneous Total Volunteer Hours
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hours of fraternal service:, TotalEstimated Volunteer Hours
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4. a. b. c. d. e.
5. Sick/disabled members and their families
Estimated hours of fraternal service:
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(Signed) __________________________________________________________ (Chief Squire)
(Signed) __________________________________________________________ (Burser)
Date: ____________________________________________________________ FORWARD TO: Supreme Council Department of Fraternal Services. COPY TO: State Deputy, State Squires Chairman, Circle File. 1728C 1/07
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