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DEGREE EXEMPLIFICATION REPORT

REPORT DATE:

TO:

DISTRICT NUMBER *

JURISDICTION *

DEGREE DATE: * +

HOST COUNCIL NUMBER: *

SUBMITTED BY
*

TITLE *

MEMBERSHIP #
*

EMAIL: *

DIOCESE: *

ONLY SUBMIT ONE REPORT PER DEGREE.

DO NOT REPORT MULTIPLE DEGREES ON A SINGLE FORM

DEGREE EXEMPLIFIED (CHECK ONLY ONE): *

EXEMPLIFICATION OF CHARITY, UNITY AND FRATERNITY

ADMISSION/FIRST DEGREE

FORMATION/SECOND DEGREE

KNIGHTHOOD/THIRD DEGREE

LOCATION:

Church

Council Chamber

Other

TEAM COUNCIL:

TEAM NAME:

CONFERRING OFFICER'S NAME:

HONOREE (IF DESIGNATED):

TOTAL NUMBER OF CANDIDATES:

LENGTH OF DEGREE (HOURS):

CANDIDATE DETAILS (EXEMPLIFICATION OF CHARITY, UNITY AND FRATERNITY ONLY)

NEW MEMBER(S):

PRIEST(S):

E-MEMBER(S):

ADVANCING MEMBER(S):

TOTAL OBSERVING:

Please list the council and the number of candidates below.

Please list the council and the number of candidates below.

GENERAL OBSERVATIONS: *