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Instructions
Member # :
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Language:
A
NNUAL
S
URVEY
O
F
F
RATERNAL
A
CTIVITY
JANUARY 1, 20
THRU
DECEMBER 31, 20
A
SSEMBLY
N
UMBER
Jurisdiction
Section I. Fraternal Program Activities
F
AITH
A
CTIVITIES
(where applicable)
CHARITABLE
DISBURSEMENTS
HOURS
OF SERVICE
a. RSVP Program
b. Church Facilities
c. Catholic Schools/Seminaries
d. Religious/Vocations Education
e. Prayer & Study Programs
f. Sacramental Gifts
g. Miscellaneous Faith Activities
Total Faith Contributions
F
AMILY
A
CTIVITIES
(where applicable)
a. Food for Families
b. Family Formation Programs
c. Keep Christ in Christmas
d. Family Week
e. Family Prayer Night
f. Miscellaneous Family Programs
Total Family Contributions
C
OMMUNITY
A
CTIVITIES
(where applicable)
a. Coats For Kids
b. Global Wheelchair Mission
c. Habitat for Humanity
d. Disaster Preparedness/Relief
e. Physically Disabled/Intellectual Disabilities
f. Elderly/Widow(er) Care
g. Hospitals/Health Organizations
h. Columbian Squires
i. Scouting/Youth Groups
j. Athletics
k. Youth Welfare/Service
l. Scholarships/Education
m. Veteran Military/VAVS
n. Miscellaneous Community/Youth Activities
TOTAL COMMUNITY CONTRIBUTIONS
L
IFE
A
CTIVITIES
(where applicable)
a. Special Olympics
b. Marches for Life
c. Ultrasound Initiative
d. Pregnancy Support
e. Christian Refugee Relief
f. Memorials to Unborn Children
g. Miscellaneous Life Activities
TOTAL LIFE CONTRIBUTIONS
TOTAL
Section II. Fraternal Commitment Activities
M
EETINGS
1. Regular
2. Social
3. Special / Committee
Total Meetings
O
THER
F
RATERNAL
C
OMMITMENTS:
Visit to the Sick
Visits to the Bereaved
Number of Blood Donations
Masses Held for Members
Hours of Fraternal Service to Sick / Disabled Member and thier Families
All information provided on this report is to be form Programs & Activities conducted January 1
st
through December 31
st
annually.
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Date
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