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Communications Society Chapters Questionnaire

ComSoc Chapters can request funding based on specified needs (special events, membership recruitment, publications, publicity activities, remuneration for special lecturers, opening a web page or other electric dissemination, chapter-related expenses). Although funding is set aside to meet these needs, it is available by request only.

Chapter & Region

IEEE Region (1 - 10):: *

Name of Chapter or Section:: *

Chapter Contact & Information

Chapter Chair: *

Address:

City:

State/Province:

Country:

E-mail: *

Tel-Office:

Tel-Home/Mobile (optional):

Chapter Funding

Did your chapter request/receive ComSoc funding last year (2012)?:

Yes

Explain briefly how funding was used? (If you received funding, this section must be filled out for 2012 funding consideration.):

Will your chapter need ComSoc funding in 2013?:

Yes

Intended Uses::

	Yes	No
Special Initiative/Project #1 (Explain below)
Special Initiative/Project #2 (Explain below)
Membership recruiting - (incentives, meetings, etc.)
Remuneration for Distinguished & Local Lecturers
Web page (or other electronic dissemination)
Newsletter, brochure, or other publicity
Administrative/General Expenses
Other

Special Initiative/Project #1- Explain & Estimated Cost :

Special Initiative/Project #2 -Explain & Estimated Cost:

Membership recruiting (incentives, meetings, etc.)- Explain & Estimated Cost:

Remuneration for Distinguished & Local Lecturers -Explain & Estimated Cost:

Web page (or other electronic dissemination) -Explain & Estimated Cost:

Administrative/General Expenses - Explain & Estimated Cost:

Other - Explain & Estimated Cost:

Total Estimated Need: $

Chapter Bank Balance

Does your chapter have its own bank account or access to a separate fund maintained by your Section for the chapter's use?:

Yes

If "Yes", please indicate year-end balance. : $

Chapter expenses last year . : $

For joint chapters: do you receive funding from other societies?:

Yes

If "yes", what was your total allocation from them last year (excluding ComSoc)?: $

Payment Method for Approved Funds

(Select One)

1. Concentration (HOP) Bank Account (6-digit number):

2. Wire Transfer (information required for successful transfer):

Yes

Complete Bank Name:

Bank -Street Address:

Bank-City:

Bank- State / Country:

Bank Account Name:

Swift#:

Note: Final decisions on funding are made by the Director-Membership Programs Development.

You may direct questions to Carole Swaim (c [dot] swaim [at] comsoc [dot] org) and Carol Cronin (c [dot] cronin [at] comsoc [dot] org)

Complete each section of the questionnaire before clicking