2019 S.A.M. Reporting Form.v4

SAMTrack.v4 Reporting Form
Before completing this form, please be aware that it is password protected. Please send an email to imperial.samdime@gmail.com to request the password
Password *

S.A.M. Temple Report
Select S.A.M. Desert
Deep South Deserts*
Mid-Atlantic Deserts*
Mid-Western Deserts*
North Eastern Deserts*
Western Deserts*
Select Temple
Alabama Temples*
Arkansas Temples*
Georgia Temples*
Florida Temples*
Louisiana Temples*
Mississippi Temples*
Missouri Temples*
Oklahoma Temples*
South Carolina Temples*
Tennessee Temples*
Texas Temples*
Bahamas/ US Virgin Islands Temples*
Alaska Temples*
Delaware Temples*
District of Columbia Temples*
Korea Temples*
Maryland Temples*
North Carolina Temples*
Virginia Temples*
West Virginia Temples*
IllinoisTemples*
Indiana Temples*
Iowa Temples*
Kansas Temples*
Kentucky Temples*
Michigan Temples*
MinnesotaTemples*
Nebraska Temples*
Ohio Temples*
Wisconsin Temples*
Connecticut Temples*
Far East Temples*
Massachuettes Temples*
New Jersey Temples*
New York/ Canada Temples*
Pennsylvania Temples*
Arizona Temples*
California Temples*
Colorado Temples*
Hawaii Temples*
New Mexico Temples*
Washington Temples*
Western Europe Temples*
Temple Contact Information
S.A.M Temple Director Name *

First NameLast Name
S.A.M Temple Director E-mail*
example@example.com
S.A.M Temple Director Phone Number*

Area CodePhone Number
Project/ Event Details
Start Date of Project/ Event

MonthDayYear
Date
End Date of Project/ Event

MonthDayYear
Date
No Activity to Report

If selected, please explain below
Explanation of no activity*
Participation
Names of Participating Mentors - Nobles ONLY*
DO NOT Enter Names of youth or Daughters
Total # of Participating Mentors:*
Total # of Participating Mentees*
Total # of Hours Spent with Mentees*
Age Range of Mentees:*

7 - 10 years old11 - 13 years old14 -18 years old
Total # of Hours (In-Kind Service for Project/ Event)
This field will auto-populate the ACTUAL In-Kind Service Hours
Activity
Was this a joint Temple/ Court project/ event?:*

YesNo
Was this a collaborative project/ event with a non-masonic organization?:*

YesNo
Name of Organization*
Example: Boy Scouts, YMCA, elementary school, library, etc.
Brief description of project/ event*

0/300
What was the outcome of your mentoring efforts?:*

0/300
Educational Goals
Did your Temple mentoring efforts assist is increasing G.P.A. of your Mentee(s)?:*

N/AYesNo
How did the mentoring efforts support the Mentee(s) in increasing their G.P.A?:*

0/300
Did your Temple mentoring efforts assist in reducing the high school drop out rate?:*

N/AYesNo
How did the mentoring efforts support the Mentee(s) in reaching their educational goals?:*

0/300
Feedback
How can the S.A.M. Mentoring Program assist your Temple in your mentoring efforts?:*

0/300
Additional Contact Information
If your Desert does not have an assigned S.A.M. Desert Director, please select this option:

No Desert Director Assigned
DESERT - S.A.M. Director *

First NameLast Name
DESERT - S.A.M. Director E-mail*
example@example.com
DESERT - S.A.M. Director Phone Number*

Area CodePhone Number
Deputy of the Desert:*

First NameLast Name
Deputy of the Desert E-mail*
example@example.com
Deputy of the Desert Phone Number*

Area CodePhone Number
Please be sure to print a copy or forward your report via email to your Illustrious Potentate and the Deputy of the Oasis.
Should be Empty:

SAMTrack.v4 Reporting Form

S.A.M. Temple Report

Select S.A.M. Desert

Select Temple

Temple Contact Information

Project/ Event Details

Participation

Activity

Educational Goals

Feedback

Additional Contact Information