REGION III COMMITTEE REPORT FORM
Assembly Location/Date:________________________________

(Please turn in this completed form to the Region Secretary before end of Assembly)

NAME OF COMMITTEE: _____________________________________________________________________________________________  

CHAIR: __________________________________	PHONE: __________________________ E-MAIL: ________________________________

SECRETARY: ________________________________________E-MAIL: ______________________________________

PROPOSED BUDGET REQUEST (Due Fall Assembly Only): ________________________

COMMITTEE MEMBERS & CONTACT INFORMATION: 

NAME						EMAIL					PHONE
1				
2				
3				
4				
5				
6				

ACCOMPLISHMENTS SINCE LAST ASSEMBLY: 

REGION III COMMITTEE REPORT FORM									Date:__________    Page 2

GOALS	
ACTIONS	TIME FRAMES	RESPONSIBLE PARTIES	COMPLETION STATUS	
1.
					
2.
					
3.
					
4.
					
5.

COMMUNICATION FOLLOW-UP METHOD	RESPONSIBLE PARTY	DATES	

			
 
AGENDA ITEMS FOR NEXT COMMITTEE ASSEMBLY:
1.________________________________________________________________________________________

2.________________________________________________________________________________________

3.________________________________________________________________________________________

 PLEASE SUBMIT ORIGINAL TO THE RECORDING SECRETARY-1 COPY WILL BE MADE FOR CHAIR 
																			R1.10