State Grange President Name *

State Grange President Phone *

State Grange President Email *

State Grange President Address *

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

Is this a personal or State Grange address? *

Enter required value Personal Email Address State Grange Email Address

State Grange Community Service Director Name *

 

State Grange Community Service Director Phone number *

State Grange Community Service Director Email Address *

Note

In order to receive monetary award and/or certificates from the National Grange, this report must be submitted to the Community Service Group. (30 days prior to certificate presentation is appreciated).

Total number of community service hours reported within your State:

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

Total number of Community Granges in your State:

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

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

Our State met the 25% threshold for $250.00 from National. *

Payment will be made via ACH - we will follow up with you.

Yes

No

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

Yes

No

Email

The following Granges are to be issued CS Certificates: *

Date to be placed on certificates:

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.

Local Grange Name and Number

Type of Certificate:

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