Name of Fraternity/Sorority:
Name of Person Submitting Form:
Name of Philanthropy Event/Project:
Date of Event/Project:
Number of Members Participating in Event/Project:
Total Amount of Money (or items) Raised:
Description of philanthropy event/project:
Verification Statement- I certify that my organization completed the philanthropy event/project identified on this form and that all the information provided is accurate.
Please provide below the information of the agency/organization the money (or items) you collected is being donated to. This will assist us to verify the information if necessary.
Did you/are you donating the money (or items) raised to an agency or organization?
Name of Agency/Organization (if you did not work with an agency, type N/A):
Name of Agency/Organization Contact Person: