620 Park Avenue #311
Rochester NY 14607-2943
585-360-4512 local | 800-462-9498 toll-free
585-486-6529 fax | e-mail

Integrity gives thanks for the generous support of the...

Evelyn and Walter Haas, Jr. Fund

E. Rhodes and Leona B. Carpenter Foundation

Annual Chapter Report Form

The bylaws of national Integrity require that chapters submit an annual report. This report is essential to helping national Integrity better serve chapters and to keep its chapter database up-to-date. It is also a requirement for initial and continued chapter certification.

If you have questions about the report, contact Administrator John Clinton Bradley at or 800-462-9498.

Part 0: Reporter

Person Completing Report
Date

Part 1: Chapter Information

Chapter Name
Official Chapter Address[1]
Official Chapter Phone Number
Official Chapter E-Mail Address
Official Chapter Web Site URL
Meeting Dates and Time (e.g., "first Fridays of every month at 7:00 p.m.")
Meeting Location[2]

Part 2: Chapter Leaders

Officer 1
Name
Title
Phone [home or cell]
E-mail
Expiration of Term

Officer 2
Name
Title
Phone [home or cell]
E-mail
Expiration of Term

Officer 3
Name
Title
Phone [home or cell]
E-mail
Expiration of Term

Officer 4
Name
Title
Phone [home or cell]
E-mail
Expiration of Term

Officer 5
Name
Title
Phone [home or cell]
E-mail
Expiration of Term

Officer 6
Name
Title
Phone [home or cell]
E-mail
Expiration of Term

Part 3: Requirements For Continued Chapter Certification

		Comments
1. Have your chapter bylaws changed in the last year?[3]
2. Has the chapter met at least three times in the past year?

Part 4: Accomplishments and Challenges (Optional)

What were your chapter’s greatest accomplishments during the past year?
What will be your chapter’s biggest challenges during the next year?
What can national Integrity and your regional vice president do to help your chapter?
Do you have other comments or questions?