Council Report Forms Booklet - Knights of Columbus, Supreme ...

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ULTRASOUND INITIATIVE APPLICATION - FOR STATE COUNCIL AND/OR LOCAL COUNCIL USE Sponsoring state or local council: _____________________________________________________________ #_____________ Council location: ______________________________ State/Province _______________ The council voted to approve proceeding with this fund raising program on (date): ____________________________________ K of C contact person: ___________________________________Title_______________________ Date: ________________ Telephone #: ________________________ Address:__________________________________________________________ Pregnancy Care Center: ___________________________________________ Telephone _____________________________ Contact person: _____________________________Title___________________ Email address: ________________________ Address _______________________________City/Town_________________ State/Province _______ Zip Code ___________ Federal Tax Status (check one): _____501(c)3 _____other Center’s Federal Tax ID/Regis. Charitable Donation # ____________ National affiliations: ______________________________________________________________________________________ Check here (_____) if this pregnancy care center has no policies that are anti-Catholic in any way and does not engage in practices that would tend to lead Catholic women away from their faith. Check here (_____) if this pregnancy care center does not advocate or refer for birth control. Does the center require employees, volunteers or patient/clients to sign a Statement of Faith? Yes ____ (If yes, please enclose a copy.) No _____ Please verify each of the following statements and indicate with a checkmark: _____ The center complies with all state/provincial/local laws/regulations to operate an ultrasound machine. _____ The center has a medical doctor who will oversee the ultrasound machine operations. The medical director is: Dr. _________________________________________________________________________ Address: _________________________________________________________________________ _____ The machine will be staffed with trained, licensed, experienced medical personnel. _____ The center has adequate insurance for operation of the ultrasound machine. Please list the council number of any other councils which assisted in or contributed to the state council’s/ council’s fund raising efforts. #____________________ #____________________ #____________________ #____________________ Please briefly describe anything particularly noteworthy about the pregnancy center (location, services, etc.) and major fundraising programs used by your council to raise the required funds (use additional paper if needed): ___________________ ______________________________________________________________________________________________________ Ultrasound machine manufacturer:____________________________________ Model:________________________________ Type of ultrasound machine to be purchased: ____ 2-D ____3-D ____4-D ____other _____________________________ List price: $_______________________________ (check one) _____ new ____ refurbished Actual cost: $_____________________________ (50% to be paid by the Supreme Council) (attach sales order) Total amount raised to date by the council (must be at least 50% of the machine’s cost): $ _____________________________ Please make check payable, in the amount of $_____________________________, to (circle one): _____________________ State Council Charities (EIN #_______________) Pregnancy care center listed above Signed: State Culture of Life Director or Grand Knight: ___________________________________ Date: ________________ Telephone #: _____________________________ Email address: _________________________________ Signed: State Deputy: ______________________________________________________ Date: ____________________ Mail check to: __________________________________________________________________________________________ 46 Enclosures: _____ Statement of Faith (if one is used by center) Submit to: Culture of Life, Marriage and Family Values Office _____ Copy of Ultrasound Machine Sales Order Knights of Columbus _____ Center’s Mission Statement 1 Columbus Plaza _____ Other supporting documents New Haven, CT 06510-3326 4886 3/13
Please note the following when ordering coats: COATS FOR KIDS ORDER FORM • Coats come in boxes of 12, and must be ordered by the box. Each box will contain either girls coats or boys coats, but not both. The cost is $195 per case. • All boxes of coats will contain a variety of colors, styles and sizes. We cannot accommodate orders for specific quantities in specific sizes. • There is no need to include payment with the order. Once the coats have shipped, and shipping charges have been determined, the Supreme Council will bill the local council, state council or district deputy. Payment should be made by check (payable to Knights of Columbus). Please note that the Supreme Council will pickup 50% of the shipping costs for all coats ordered through Coats for Kids. • Please allow 23 weeks between the receipt date of the order and delivery of the coats. TOTAL NUMBER OF BOXES OF COATS REQUESTED NUMBER OF BOXES OF BOYS COATS NUMBER OF BOXES OF GIRLS COATS ____ ____ ____ PLEASE SHIP THE COATS TO THE FOLLOWING (Provide the name of the person who will receive the shipment, as well as a physical address – no P.O. Boxes): PLEASE SEND THE INVOICE FOR THE COATS TO THE FOLLOWING Authorized Signature (Grand Knight, District Deputy or State Deputy) _________________________ ___________________ ___________ ___________________________ Name Title Member # EMail address _______________________________ ____________________________ State Name, District # or Council # State Abbreviation (2 Characters) Completed forms can be emailed to fraternalforms@kofc.org, faxed to 2037524108 or mailed to Knights of Columbus, Attn: Department of Fraternal Services, 18th Floor, 1 Columbus Plaza, New Haven, CT 06510 Every Program Represents a Membership Recruitment Opportunity! 5029 3/13 47
Page 1 and 2: COUNCIL REPORT Forms Booklet KNIGHT
Page 3: SEMIANNUAL COUNCIL AUDIT REPORT FOR
Page 7: Keep Christ in Christmas Poster Con
Page 11 and 12: ANNUAL REPORT KNIGHTS OF COLUMBUS R
Page 13: FREE THROW PARTICIPATION REPORT FOR
Page 17 and 18: INSTRUCTIONS FOR COMPLETING Detach
Page 19 and 20: PARTNERSHIP PROFILE REPORT WITH SPE
Page 21: KEEP CHRIST IN CHRISTMAS POSTER CON
Page 25 and 26: STATE COUNCIL SERVICE PROGRAM AWARD
Page 27: SUBSTANCE ABUSE AWARENESS POSTER CO
Page 31 and 32: REFUND SUPPORT VOCATIONS PROGRAM (R
Page 33 and 34: FOOD FOR FAMILIES REIMBURSEMENT PRO
Page 35 and 36: COLUMBIAN AWARD APPLICATION 20__-20
Page 37: REPORT OF OFFICERS CHOSEN FOR THE T
Page 40 and 41: FAMILY DIRECTOR: MEMBERSHIP NUMBER
Page 42 and 43: Military experience City/State/Coun
Page 45: COLUMBIAN SQUIRES INQUIRY KIT ORDER
Page 51 and 52: REPORT OF ROUND TABLE COORDINATOR 2
Page 56: 1436 3/13

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