Post-Event Reporting Form (Fundraising and Educational Events)

IMPORTANT: This form must be completed in detail and filed with the NCCC 14 days following the fundraising event. Complete the form below as accurately as possible.

Chapter Name (if not applicable type N/A)

This is a required question

Contact or Chapter Leader Name

This is a required question

Contact Email Address

Must be a valid email address

This is a required question

Contact Phone Number:

This is a required question

Event Name

This is a required question

Event date

This is a required question

Number of Attendees

This is a required question

Fundraising Revenue and Expenses

Skip this section if the event was an educational event

Revenue

Contributions—cash

This is a required question

Contributions—checks

This is a required question

Contributions—online

This is a required question

Ticket sales/admission fees

This is a required question

Sale of advertising/vendor fees

This is a required question

Sponsor fees

If you have sponsors, please enter their information at the bottom of this form. They will be sent a letter of thanks for their tax records.

This is a required question

Other

Please describe

This is a required question

Revenue—subtotal

This is a required question

Expenses

Facility Rental or Equipment

This is a required question

Printing

This is a required question

Postage

This is a required question

Advertising/publicity

This is a required question

Materials purchased from NCCC

This is a required question

Decorations/favors/prizes

This is a required question

Food/drinks

This is a required question

Other expenses

Please describe

This is a required question

Expenses—subtotal

This is a required question

Revenue Distribution

Revenue—subtotal

Enter from above

This is a required question

Revenue for chapter

70% of revenue (Multiply subtotal above by 0.70)

This is a required question

Expenses—subtotal

Enter from above

This is a required question

Net revenue

Subtract expenses from revenue for chapter to calculate net revenue for chapter

This is a required question

Please print a copy of this form and submit it with all receipts, invoices, check requests and any other documentation needed along with all funds collected to NCCC at: ASHA/NCCC PO Box 13827 Research Triangle Park, NC 27709 PLEASE INCLUDE SIGNATURE DELIVERY WHEN YOU SEND YOUR PACKAGE.

Sponsors and In-kind donations

If you had paid sponsors for your event or received in-kind donations, please complete the section below. If you had more than two sponsors/in-kind donation, please provide details on on additional sheet and submit that to your chapter manager via email.

Sponsor/Company name

This is a required question

Contact name

This is a required question

Contact email

This is a required question

Address

This is a required question

Donation amount—cash

This is a required question

Donation value—in-kind

This is a required question

Goods received in-kind

Please describe

This is a required question

Total

This is a required question

Sponsor/Company name

This is a required question

Contact name

This is a required question

Contact email

This is a required question

Address

This is a required question

Donation amount—cash

This is a required question

Donation value—in-kind

This is a required question

Goods received in-kind

Please describe

This is a required question

Total

This is a required question