Student Chapter Annual Report Form

Please complete the following information regarding your section:
Due each year by May 31st.

All fields marked by an * are required

*Name of Student Chapter:

*Joint Chapter with other Societies? Yes No

If yes, please list:

*Date:

*Advisor Name:

*Advisor Phone:

*Advisor Email:

*Reported Year:

*Preparer's Name:

*Email Address:

*Preferred Mailing Address for Chapter:

*Web Site Address:

Current Student Chapter Officers

President:

Email Address:

Vice President:

Email Address:

Treasurer:

Email Address:

Secretary:

Email Address:

Program Chair:

Email Address:

Current Members

*Number of Student Members:

Upload Current Member Roster:(Only Doc, Pdf and Xls files are accepted)

Treasurer's Report

*Beginning Balance:

*Date:

Plus Income

*Meetings:

*Personal Dues:

*OSA Member Reimbursement:

*Educational Outreach Grant:

* Other Grants/Awards/Contests:

*Other:

*Total Income:

Less Expenses

*Meetings:

*Mailings:

*Other (please specify):

*Total Expenses:

*Ending Balance:

Education Outreach Activities

*List name of Ed. Outreach Programs: