Fillable Financial Form Fillable Financial Form Annual Financial Status Report Calendar Year Chapter Name ALL FUNDS ON HAND as of 31 December Which are composed of: 1) Chapter Account: $____________ 2) Memorial Fund: $____________ 3) Scholarship Fund: $____________ 4) Other Fund: $____________ TOTAL $____________ REQUESTED IMBURSEMENT TO CHAPTER ACCOUNT 1) Operating and administrative expenses provision = $500 + $5 per attendee (attach signed attendance lists) $500 $______500________ Total Attendance for the year:_______ attendees # of attendees * $5 = $_________________ TOTAL provision $_________________ 2) Reimbursements a) Meeting expenses: (not including alcoholic beverages) $_________________ (attach receipts for all meeting expenses) b) Expenses for Speakers: [80% reimbursement to $500 max] i) Honoraria: $____________ ii) Travel Expenses: $____________ Total Expenses $___________ Total Expenses * 0.8 $___________ TOTAL Reimbursement [not to exceed $500] $_________________ c) College Participation: [reimbursement to $500 max] i) Awards/Activities/Scholarships: (not including payment of ASA dues) $____________ ii) Student Travel Expenses: (not including travel to national meetings) $ ____________ Total Expenses $___________ TOTAL Reimbursement [not to exceed $500] $_________________ d) High School Awards Presented: $_________________ TOTAL Reimbursement [not to exceed $200] $_________________ e) Talks at Local Schools: $_________________ TOTAL Reimbursement [not to exceed $500] $_________________ TOTAL IMBURSEMENT $_________________ If the total imbursement plus the remaining funds in the chapter bank account is over $2000, then subtract that amount over $2000 from the requested imbursement to arrive at the requested amount. TOTAL REQUESTED IMBURSEMENT $_________________ Treasurer:_________________________President:________________________Date:____________; If you are human, leave this field blank. Submit Δ