Report Date: ____________________________
Lodge Name: _____________________Number _______________ Location ___________
Number _______________ Location ___________State Deputy’s Name: _____________________________________________
Questionnaire / Check List YesNo
YesNo NUMBER OF MEETINGS STATE DEPUTY ATTENDED
DURING LAST QUARTER?_______________________
_______________________ DO LODGE MEMBERS REALIZE STATE DEPUTY IS THE
REPRESENTATIVE OF THE STATE PRESIDENT AND
GRAND LODGE?_______________________
_______________________ DO LODGE MEMBERS RESPECT STATE DEPUTY? _______________________
DOES STATE DEPUTY DISCUSS MESSAGES AND
ACTIVITIES OF GRAND LODGE? _______________________
_______________________ DOES STATE DEPUTY TAKE ADVANTAGE (OVERDO)
HIS/HER POSITION?________________________
________________________ DOES STATE DEPUTY PROVIDE ASSISTANCE? ________________________
________________________ ARE LODGE MEMBERS SATISFIED WITH STATE DEPUTY? ___________________
ARE LODGE MEMBERS DESIROUS OF OBTAINING A NEW
STATE DEPUTY? ___________________
___________________ IS STATE DEPUTY PERMITTED TO ATTEND COUNCIL
MEETINGS? ___________________
___________________ DOES PRESIDENT HAVE ANY SPECIAL PROBLEMS OR IS
IN NEED OF HELP ON ANY LODGE MATTERS? ___________________
___________________REMARKS / RECOMMENDATIONS:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
MAIL TO: STATE DEPUTY CHAIRMAN
GRAND LODGE OF MASSACHUSETTS _____________________________ ORDER SONS OF ITALY IN AMERICASIGNATURE OF LODGE PRESIDENT 93 CONCORD AVE., BELMONT, MA 02478
