Adult Literature Report Form

ADULT  LITERATURE REPORT IOWA USFW

 

Name of Society___________________________________

 

Number of Women and Men participating in Course_____

 

Number of Women completing the Reading Course_____

 

Names of those completing the Reading Course

 

____________________________________________________________________

 

____________________________________________________________________

 

____________________________________________________________________

 

____________________________________________________________________

 

____________________________________________________________________

 

 

Number of Advocates_____________

 

Number of Blueprints_____________

 

Number of Programs_____________

 

Report is due June 20, 2014

 

Mail to: Cathie Zeliadt

                     4103 SW 5th St.

                     Des Moines, IA  50315

  

Name, Address, and Phone number of person making this report:

            ____________________________________________________

 

            ____________________________________________________

 

            ____________________________________________________

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