Annual Survey of Fraternal Activity

For the twelve month period ending December 31, 2016

Due by: January 31

Important:

In sections II and III use WHOLE DOLLAR AMOUNTS ONLY - no decimals.
UNITS IN THE PHILIPPINES SHOULD REPORT ALL FINANCIAL DATA IN PESOS.
Include financial contributions and hours of community service from all related programs (i.e. council corporations, parish round tables, etc.) Include Columbian Squires totals only if the circle does not complete a separate report.
Include your e-mail address in the space provided to ensure you receive a copy for your files. You will also be given the opportunity to print a copy of your form.

I. NUMBER OF MEETINGS HELD DURING YEAR:
1. Regular:
2. Social:
3. Special:
TOTAL NUMBER OF MEETINGS HELD:

III. CHARITABLE DISBURSEMENTS:
Church Activities:
1.	a. Church Facilities:	$
	b. Catholic Schools:	$
	c. Religious Education:	$
	d. Seminarians/RSVP:	$
	e. Seminaries:	$
	f. Vocations Projects:	$
	g. Miscellaneous:	$
Total Church Disbursements:		$
Community Activities:
2.	a. Elderly:	$
	b. Physically Disabled:	$
	c. Special Olympics/Intellectual Disabilities:	$
	d. Veteran Military/VAVS:	$
	e. Food for Families:	$
	f. Victims of Disasters:	$
	g. Hospitals/Institutions/Health Organizations:	$
	h. Global Wheelchair Mission:	$
	i. Community Wide Projects:	$
	j. Habitat for Humanity Projects:	$
	k. Miscellaneous:	$
Total Community Disbursements:		$
Culture of Life Activities:
3.	a. Donations:	$
	b. March for Life:	$
	c. Birthright/Baby Showers:	$
	d. Baby bottle campaign:	$
	e. Memorials to unborn children:	$
	f. Ultra-Sound Initiative:	$
Total Culture of Life Disbursements:		$
Youth Activities:
4.	a. Columbian Squires:	$
	b. Scouting:	$
	c. Youth Groups:	$
	d. Youth Welfare/Services:	$
	e. Athletics:	$
	f. Scholarships/Education:	$
	g. Coats for Kids:	$
	h. Miscellaneous:	$
Total Youth Disbursements:		$
TOTAL CHARITABLE (Church, Community, Culture of Life and Youth) DISBURSEMENTS:
		$

IV. FRATERNAL COMMITMENT:
Number of Visits to:
1.	a. Sick:
	b. Bereaved:
Total Visits:
2. Number of Blood donors:
3. Habitat for Humanity Projects:
Estimated hours of volunteer service:
4.	a. Church:
	b. Community:
	c. Youth:
	d. Habitat for Humanity:
	e. Culture of Life:
	f. VAVS:
	g. Food for Families:
	h. Special Olympics:
	i. Miscellaneous:
Total Volunteer Hours:
Estimated hours of fraternal service:
5. Sick/disabled members and their families:


Forwarding Instructions: Including your e-mail address allows you to receive a copy of your report via e-mail so that you can forward an electronic copy to any e-mail recipient at a later date. Enter the e-mail addresses you have available (Vice Supreme Master and Master). Leave the line blank if you are unsure of the correct e-mail address. You will have the opportunity to print a copy of the form after you submit the form in the next step. Click the "Continue" button to confirm and submit your form.

Yourself (Assembly Copy):
Vice Supreme Master:
Master: