Investigation Committee Report
Complete this form to evaluate a petitioner for membership into a subordinate Prince Hall Affiliated Lodge of the MWPHGLTN – District #19.
Lodge Information
Please provide the details of the lodge.
Lodge Name
*
Location
*
Petitioner Information
Please provide your personal details.
Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
*
What is your occupation and where are you employed?
*
Do you believe in the existence of a Supreme Being or Higher Power?
*
Yes
No
Would you have any issues reading chapters and verses from the Holy Bible (King James Version)?
*
Yes
No
In your own words, why do you want to become a Mason?
*
What do you know about Prince Hall Masonry?
*
Do you have any feelings about being referred to as “Brother”?
*
Yes
No
Can you keep a secret?
*
Yes
No
Have you heard any negative information about Masonry?
*
Yes
No
If so, what have you heard?
Would you support a brother in need of your assistance?
*
Yes
No
Do you believe in being charitable?
*
Yes
No
If so, what do you view as charity?
Are you prejudiced against any race or religion?
*
Yes
No
If married or in a relationship, have you discussed becoming a Mason with your partner, and does your partner know you have petitioned the Lodge?
*
Yes
No
If accepted, what do you think you could contribute to a Masonic Lodge?
*
Did you voluntarily ask to join our Lodge, or did someone ask you?
*
Voluntarily Asked
Someone Asked
Do you have any problems with addiction to drugs or alcohol?
*
Yes
No
Do you have any objection to wearing Masonic dress which includes a black suit, white shirt, black string necktie, and black dress shoes?
*
Yes
No
Have you ever been a member of a cult or organization that expresses anti-religious viewpoints?
*
Yes
No
Are you able to attend meetings twice a month, usually starting around 7:30 PM and ending around 9:30 PM?
*
Yes
No
Do you have any physical conditions which may prevent you from performing any task you may be asked or assigned by the Lodge?
*
Yes
No
Financial Obligation Disclosure: Inform the profane of their financial obligation if accepted, including costs and payments prior to advancing to the next degree. (Informed by committee)
*
Do you have any questions about anything we have discussed?
Investigation Committee Section
For completion by the Investigation Committee.
Petitioner’s Name
*
First Name
Last Name
Chairman of Investigation Committee: Name
First Name
Last Name
Chairman of Investigation Committee: Signature
*
Chairman Email
*
example@example.com
Investigation Committee Members
*
Rows
Name
Signature
Favorable
Unfavorable
Member 1
Member 2
Member 3
Member 4
Petitioner Presented By (List up to 2 presenters)
Rows
Presenter Name
1
2
Committee Finding: In accordance with the Prince Hall Masonic Code and Constitution of the State of Tennessee, Article IV, the Investigation Committee finds the above petitioner:
*
Favorable
Unfavorable
Committee Recommendation
*
Favorable — Yes
Unfavorable — No
Print
Submit Report
Submit Report
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