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* 1. Chapter Name

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* 2. Report for:

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* 3. Report submitted by (first & last name):

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* 4. Email address:

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* 5. Financial Donations Total for Quarter:

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* 6. Details of Financial Donations - Please include (1) Organization Name Donation Went to (2) Month in which donation was raised (3) Amount to individual organization (4) Any additional details, such as; member donations, match by chapter, etc.:

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* 7. Goods Donations Total for Quarter (estimate equivalent dollar amount):

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* 8. Details of Goods Donations - Please include (1) Organization Name Donation Went to (2) Month in which donation were collected (3) Amount to individual organization (4) Any additional details, such as; member donations, match by chapter, etc. (Examples: 14 backpacks stuffed with school supplies donated by members and provided to XX School in Feb.):

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* 9. Volunteer Hours Total for Quarter:

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* 10. Details of Volunteer Hour Donations - Please include (1) Organization Name Volunteer Hours were spent with (2) Month in which volunteer work was done (3) Amount to individual organization (4) Any additional details, such as; # of volunteer hours completed by members, board members etc (This is not intended to include volunteer hours attending SHRM Chapter board meetings or SHRM Chapter work):

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* 11. Additional Community Impact Efforts Not Covered by Questions Above:

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