ANNUAL SURVEY OF FRATERNAL ACTIVITY FOR TWELVE MONTH PERIOD ENDING DECEMBER 31, 2009 20___ S Circle Number ___________________ Location ____________________________________ city/town
I. NUMBER OF MEETINGS HELD DURING YEAR:
Youth Activities
1. Regular 2. Social 3. Special
TOTAL NUMBER OF MEETINGS HELD
,
II. ACTIVITY EXPENSE 1. a. b. c. d. e. f.
Printing and Postage Food and Refreshments Prizes Projects Entertainment Miscellaneous
TOTAL ACTIVITY EXPENSES
0
DOLLARS ONLY:
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,
,
Church Activities Church Facilities Catholic Schools Religious Education Seminarians/RSVP Seminaries Vocations Projects Miscellaneous
0
Total Church Disbursements
DOLLARS ONLY:
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,
,
Community Activities 2. a. b. c. d. e. f. g. h. i. j. k. l.
Elderly Physically Disabled Special Olympics Citizens with Intellectual Disabilities Human Needs Pro-Life Programs Victims of Disasters Hospitals/Institutions Health and Service Organizations Community wide Projects Habitat for Humanity Miscellaneous
Total Community Disbursements
DOLLARS ONLY:
Columbian Squires Scouting Youth Groups Youth Welfare/Services Athletics Scholarships/Education Miscellaneous
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Total Youth Disbursements
,
,
0
TOTAL CHARITABLE (CHURCH, COMMUNITY, YOUTH) DISBURSEMENTS
,
,
0
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3. a. b. c. d. e. f. g.
IV. FRATERNAL COMMITMENT:
III. CHARITABLE DISBURSEMENTS:
1. a. b. c. d. e. f. g.
state/province
1. Number of visits to: a. Sick b. Bereaved
0
Total Visits 2. Number of blood donors 3. Habitat for Humanity
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Estimated hours of volunteer service:
0
4. a. b. c. d. e.
Church Community Youth Habitat for Humanity Miscellaneous
DOLLARS ONLY:
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Total Volunteer Hours
0
Estimated hours of fraternal service: 5. Sick/disabled members and their families
(Signed) __________________________________________________________ (Chief Squire)
(Signed) __________________________________________________________ (Burser)
Date: ____________________________________________________________
0
FORWARD TO: Supreme Council Department of Fraternal Services. COPY TO: State Deputy, State Squires Chairman, Circle File. 1728C 1/07