State Grange President Name *

State Grange President Phone *

State Grange President Email *

State Grange President Email Address *

Please indicate if using a "Personal" or "State Grange" address for the President.

State Grange Address

Personal Address

State Community Service Director Name *

 

State Community Servie Director Phone number *

State Community Service Director Email Address *

Total number of community service hours reported within your State:

Number of Project Sustenance hours (included in total number above):

Total number of Subordinate Granges in your State:

(Do not include Pomona – Junior – Youth. Send Junior & Youth reports to those respective Departments.)

Total number of Subordinate Grange community service reports received by your State:

Our State met the 25% threshold for $250.00 from National. Method of payment TBD and communicated. *

Yes

No

Please email CS Certificates* for printing and presentation to: *

Yes

No

Email

Our State did not meet the 25%; however, please email CS Certificates* for printing and presentation

Email

The following Granges are to be issued CS Certificates: *

Local Grange Name and Number

Local Grange Name and Number *

Type of Certificate: *

Example: First Place, Honorable Mention, Outstanding Service, etc.

Local Grange Name and Number

Type of Certificate:

Example: First Place, Honorable Mention, Outstanding Service, etc.

Local Grange Name and Number

Type of Certificate:

Example: First Place, Honorable Mention, Outstanding Service, etc.