General Information *required fields
Chapter
School
State
Chapter Website
Sponsor name
*
Sponsor e-mail
Sponsor office phone
*
Sponsor fax
Sponsor Address
City State Zip
Faculty secretary-treasurer name
Faculty secretary-treasurer address
Whom should we contact on your campus with a letter of thanks for your efforts on behalf of PGM?
Name and title
Address
The following officers will serve for the coming academic year: (Please include names and mailing addresses of officers for the fall semester so they will receive the PGM Newsletter. If
elections are held in the fall, let us know this information at that time.)
President name
President address
Vice-president name
Vice-president address
Other officer name
Other officer address
Organization Improvement
Does you chapter need recruiting materials?
Would you like headquarters to call you about any areas of concern you have? Please give a description of the concern or questions you have and a good time to reach you:
PGM C ommunications
PGM Newsletter is a communication link for chapters.
How can we improve the PGM Newsletter?
What can Headquarters, your Regional Chancellor or Governor do to assist you?
New IRS Requirement
Pi Gamma Mu is a 501©3 tax exempt organization. Every year we have to file a Form 990 with the Internal
Revenue Service. The IRS has redesigned the Form 990 and changed the requirements for those filing this
form. Every chapter of Pi Gamma Mu is required to have an EIN number. For those who have an EIN number,
we assume you are already filing the form 990-N for your chapter. Headquarters is in the process
of getting an EIN number for every chapter who does not currently have one (we will mail you a copy of the letter
from the IRS that has your EIN number). We will file a form 990-N for each of these chapters, but need
your help to do this. It is vitally important that you fill out the following information:
Do you have gross revenues over $25,000?
No
Do you have an EIN number?
No
Yearly Stats & Activity
The following information is used by the Awards Committee in making determination of chapters
deserving consideration for the Rolls of Distinction and Merit. Chapters named to the Roll of Distinction
are strongly active chapters that evidence activity and programming that reflects the overall ideals of Pi Gamma
Mu and contribute significantly to their institutions and communities. Chapters named to the Roll of Merit
are active chapters that represent similar activities, but at a somewhat lower level.
How many new members did you initiate last year?
Students
Compared to the previous year, did your membership....
increase
How would you rate the image of your chapter on campus?
Select one
Excellent
Good
Fair
Poor
Overall evaluation of your year:
Select one
Very active
Active
Somewhat active
Inactive
Activities Summary Provide a summary of your chapter's activities this past academic year, plus details of special programs, meetings,
initiations, trips or tours, guest lecturers, or service projects (if you have copies of programs, press
releases or publicity, news coverage, letters, photographs, etc. that verify such activity, please send by mail.)
Activities are unique to each chapter. The nature of these activities will reflect the goals and membership
of each chapter, and sometimes the nature of the institution. Some chapters support only one significant
event each year, while others are involved in a variety of smaller activities. The number or nature of
activities is up to each chapter, but in the end what is important is how those activities impact locally.
Sender's Name:
Sender's Email:
Do you wish to send supporting documents at this time?
No
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