Greek Organization Information:

Name of Greek Organization: ______________________________________________

Name of Philanthropy Project: ____________________________________________

Number of Members Participating in Project: _______ Total Money Raised: ______

Describe Philanthropy Project: ____________________________________________
______________________________________________________________________

__________________________________        _________________________________
Print Name of Philanthropy Chair                       Signature

Agency Information:

Name of Agency Organization: ___________________________________________

Address: ______________________________________________________________

Telephone Number: _____________  Name of Agency Contact: ________________

AGENCY CERTIFICATION OF PHILANTHROPY PROJECT

Date of Project: ______ No. of Members Participating: _____ $ Raised: ________

I certify that the Greek organization above completed the Philanthropy project identified on this form, and that all information provided is accurate.

_________________________________                  ________________________
Signature of Agency Contact                                               Date

FOR USE BY THE OFFICE OF GREEK LIFE ONLY:

Date Form Received: _________________  By: ______________________________

Distribution:  Office of Greek Life  ____               Chapter Advisor _____           National Office  _____