Volunteer Man-Hours and Financial Contributions Report Form

• SUBMIT FORM BETWEEN APRIL 1, 2012 to APRIL 30, 2013

  This form maybe submitted by Chapters or individual members at anytime.
• Submitted by:*

  prefix

  first name

  middle name

  last name
• Chapter Name & Number:*
• In:*

  Address Line 1
  Address Line 2
  City	State
  Zip Code	Country
• Email Address:*

  eg. xyz@domain.com
• MAN-HOURS OF SERVICE:

  Calculate the number of members participating x hours spent = man hours. (Include planning, meetings, phone calls, travel, prep work and actual activity time.)
• A. Community, Civic or Church Service*

  Example: Child ID, highway cleanup, parades, service dogs, blood drives, cemetery decorating, fund raising for infirmed, hostessing after funerals, etc.
• B. Masonic Youth Groups*

  Example: Time spent with Job's Daughters, DeMolay, Rainbow for Girls. Include mentoring, activities, organizing, transportation, meetings, chaperoning, etc.
• C. Other Youth Groups*

  Example: Include mentoring, activities, organizing, transportation, meetings, chaperoning, and time spent with Masonic Band Camp, 4-H, Boy Scouts, Girl Scouts, FFA, etc.
• D. Social Work*

  Example: Assisting, entertaining and/or visiting with the infirmed, long term care or nursing home residents, temporarily disabled, permanently disabled, shut-ins, etc.
• E. Masonic Homes*

  Example: Assisting in any capacity at the Masonic Home in Plattsmouth, NE and/or the Masonic Eastern Star Home for Children in Fremont, Nebraska.
• F. Others*
• Describe Others:*
• TOTAL MAN HOURS OF SERVICE*

  Place Total Here
• FINANCIAL CONTRIBUTIONS:

  Include all contributions, donations, honorariums, cost of gasoline/mileage, groceries, cleaning supplies, building supplies, tools, papers, ink, pens/pencils, stamps, banners, decorations, telephone calls, building rent, utilities used during meetings/prep work/actual time of activity, etc.
• A. Community, Civic or Church Development*
• B. Scholarships*
• C. Masonic Youth Groups*
• D. Other Youth Groups*
• E. Masonic Eastern Star Home for Children - Fremont, Nebraska*
• F. Masonic Home - Plattsmouth, Nebraska*
• G. Social Work/ Infirmed/ Disabled*
• H. Others:*
• Describe Others:*
• TOTAL FINANCIAL CONTRIBUTIONS*

  Place Total Here
•  

SUBMIT FORM FOR ACTIVITIES APRIL 1, 2012 to APRIL 30, 2013 Powered by Form2Go