Lodge Achievement Form Year of Rating 2015 (for calendar year ending December 31)

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Lodge Achievement Form Year of Rating 2015 (for calendar year ending December 31) Lodge name and number: City: State: Sons of Norway s Lodge Achievement program honors outstanding lodges and celebrates their excellence. Lodges can earn a total of 72 points for 2015. These points are gathered from three different sources: A. The Lodge Achievement Form (39 points): The lodge secretary can choose one of 3 options when completing and submitting this form: * Fill out the enclosed paper version of the form by hand and mail it to the Zone Director. * Download the Editable PDF version of the form from www.sonsofnorway.com/laf and type answers in on the computer. Print out the form and mail it to the zone director or email it as an attached file to the zone director. * NEW for 2015 Complete the online survey version of the form using the link on www.sonsofnorway.com/laf, which will be available starting 11/15/2015. This online version does NOT need to be printed or emailed. Just hit the submit button on the screen at the end. Lodges must use one of these three methods provided to submit their information. The Lodge Achievement Form is due 03/01/2016. Supporting documents: For mailed or emailed submission, please attach any supporting documents such as newspaper clippings and photos. Attachments will not be returned. If you are using the new online survey version, any supporting documents should be mailed to Sons of Norway Headquarters or emailed as an attachment to fraternal@sofn.com. B. Zone Director s Form (8 points): The Zone Director receives the LA Rating Form from the lodge secretary. He/She adds points based on district event participation and district delegates and forwards the paperwork on to the District President. C. District President Form (25 points). The District President adds points based on membership growth, insurance participation (if applicable) and the timely filing of Lodge Liability Payments, IRS 990, Financial Statements, and D63 Lodge Officer Update forms. In addition to the 25 earnable points, the District President can award up to 10 extra credit points to each lodge. Nearly all lodges who complete the LA Rating Form will qualify for a Merit Award. These come in three levels: Gold, Silver and Bronze. The points levels needed to achieve each of these awards are as follows: * Gold Merit Award: 58 points * Silver Merit Award: 47 points * Bronze Merit Award: 35 points Gold Merit level lodges are considered by the District President for the District Lodge of the Year Awards. All lodges are sorted into size tiers based on their district median, so each District will award two LOY awards: one for the best large lodge and one for the best small lodge. These top lodges are then evaluated by the International Board of Directors which selects the two International Lodge of the Year winners (one large and one small). These winning lodges will be honored at the 2016 District and International Conventions. NEW for 2015 - if your lodge tracked their events online using FraternalsGive.org, you do not need to complete the AFA Lodge Activity Report on page 2. Otherwise, you must complete this page to qualify for Lodge of the Year and Merit Awards. Sons of Norway uses these numbers to illustrate the beneficial effects we have in our lodges and communities. They are also used to protect our status as a tax exempt organization. Questions? Contact Membership Services at Sons of Norway Headquarters: 1-800-945-8851 x643 or fraternal@sofn.com. Lodge Achievement Form 2015

AFA Lodge Activity Report (for calendar year ending December 31) Lodge name and number: City: State: Instructions: Did you track your lodge activities in 2015 using FraternalsGive.org? Yes - You do not need to complete this page, AFA Lodge Activity Report. Add 3 points to the bottom and continue to page 3. - Please complete this page to be considered for Lodge of the Year and Merit Awards. 1. Events: Count the number of Community and Fraternal Events organized by your lodge in 2015. Enter these numbers in the Events boxes below. 2. Member Hours: The cumulative number of hours members spent working for Sons of Norway in 2015 both at events and on their own. Event example: Two hour lodge meeting. 3 lodge officers ran the meeting and 2 members served coffee and cookies. 5 total volunteers multiplied by 2 hours = 10 member hours for the event. On their own example: Lodge editor spent 3 hours working on the newsletter by himself each month. 12 months = 36 hours to add to year s total fraternal hours. The time travelled to and from events can be added to the total member hours. To determine travel time, estimate how long it takes the typical member to drive to and from an event. Then, multiply this amount of time by the total number of members who volunteered at your events throughout the year. For example: Typical member travel time to/from monthly lodge meeting:.5 hour Total number of volunteers at average lodge meeting: 6 officers and members.5 hour x 6 = 3 hours travel time per monthly lodge meeting 12 monthly lodge meetings x 3 hours of travel per meeting = 36 hours of travel time for the year. Add this amount to your Member Hours. Record totals in the boxes below. 3. Lodge Expenditures: Community: Get total of all lodge expenditures for community service from lodge treasurer. Do not include contributions made privately by individual members. 4. Sign and date and bottom. Fraternal: Get total of all costs to maintain and operate your lodge for a year. Include all costs including hall rent, postage, utilities, office supplies, event/function sponsorship, refreshments, advertising, etc 5. Add three points at the bottom of the page. 2015 Lodge Activities Events Member Hours (Event & Individual) Community Service Activities on behalf of Sons of Norway that assist needy or improve community (visits to nursing homes, blood/food/clothing drives, scholarships, tutoring children, etc). Lodge Expenditures Fraternal Support Activities to conduct business of lodge, promote member fellowship, advance purposes of Sons of Norway, or personal development of members. Name: Office: Phone: ( ) Date: AFA Report 3 points Lodge Achievement Form 2015 2

Lodge Achievement Form Year of Rating 2015 Check the box yes or no to correspond with your answer. Add explanation where indicated. 1 PROMOTION OF HERITAGE AND CULTURE (12 POINTS) A. Did your lodge use the slide shows, videos, idea or information bank or information available from Sons of Norway?... Yes B. Did your lodge host a heritage day or similar event open to the public?... Yes Explain: C. Did your lodge programs include a folk-dancing, musical, or other performing group?... Yes Explain: D. Did your lodge participate in a parade or public festival?... Yes Explain: E. Did your lodge have at least three programs that included presentations suitable for children?... Yes List them: F. Did your lodge have a newsletter?... Yes How many issues per year? G. If so, did you send a copy of each to your district president and zone director?... Yes H. Did your lodge newsletter include articles supplied by the Sons of Norway newsletter service?... Yes I. Did your lodge sponsor at least six social events during the year?... Yes List them: J. Did your lodge receive publicity on radio or television?... Yes List them: Continued on pg 4 Lodge Achievement Form 2015

1 PROMOTION OF HERITAGE AND CULTURE (12 POINTS) CONTINUED K. Was your lodge featured and/or mentioned in a local regional, or national newspaper or magazine?... Yes Explain: L. Does your lodge have a current web site?... Yes Section 1 Points 2 PRESERVATION OF HERITAGE AND CULTURE (6 POINTS) A. Did your lodge promote the use of the Norwegian language through language classes, singing songs in Norwegian, Norwegian phrases in lodge newsletter, etc?... Yes Explain: B. Did your lodge members participate in the Cultural Skills Program?... Yes List which skills: How many of each category? C. Did your lodge support cultural skills development (hosting classes, featuring a cultural skill at a lodge meeting)?... Yes Explain: D. Did your lodge have or support a heritage library program?... Yes E. Did your lodge members participate in the Sports Medal Program?... Yes List which sports: How many of each sport? F. Did your lodge normally sing all national anthems?... Yes Section 2 Points Lodge Achievement Form 2015 4

3 LODGE AND BENEFIT MEMBERSHIP GROWTH (5 POINTS) A. Did your lodge invite guests and potential new members to all social meetings and events?... Yes B. Did your lodge have a Youth Director and/or youth program?... Yes C. Did your lodge promote Sons of Norway financial benefits and invite the Financial Benefits Counselor to speak at a meeting?... Yes D. Did your lodge provide leads to the field staff?... Yes E. Did your lodge have an active membership committee that meets at least 3 times a year?... Yes Section 3 Points 4 SONS OF NORWAY FOUNDATION AND LOCAL COMMUNITY ACTIVITIES (7 POINTS) A. Did your lodge raise scholarship funds or offer a scholarship?... Yes B. Did your lodge support any community activities, service organizations or charities with money or volunteers?... Yes Explain: C. Did your lodge implement an Adopt A School/Framtid Program and/or sponsor other youth activities in the community?... Yes Where: _ What was done? D. Did your lodge support the Sons of Norway Foundation? (Pass the Piggy, other direct contributions to Foundation pass-through on memorials, etc)?... Yes Explain: E. Did your lodge have a Foundation Director?... Yes F. Did your lodge contribute stamps to the Tubfrim Program (or to the Foundation in Canada)?... Yes G. Does your lodge prepare and utilize an annual budget?... Yes Section 4 Points Lodge Achievement Form 2015 5

5 COMPLIANCE AND PROCEDURE (6 POINTS) A. Did your lodge hold at least 8 meetings last year? (Exclude executive/board meetings)... Yes B. Did your lodge nominate, elect, and install new officers in accordance with the Constitution and Bylaws?... Yes C. Did your lodge change at least 25% of officer positions at the last elections?... Yes What percentage? D. Did your lodge use the Order of Ceremonies for appropriate meetings?... Yes E. Did your lodge follow the rules of parliamentary procedure?... Yes F. Did your lodge display the three flags at regular lodge meetings?... Yes Section 5 Points POINTS AFA Report: Subtotal Section 1: Subtotal Section 2: Subtotal Section 3: Subtotal Section 4: Subtotal Section 5: GRAND TOTAL: Lodge Achievement Form 2015 6

6 DISTRICT ACTIVITIES (Get lists of qualifying events from your Zone Director) A. B. C. D. E. F. G. H. 7 2016 LODGE GOALS Please enter four of your 2016 Lodge Goals. You might consider goals for membership and retention, cultural skills activity, programs, Sons of Norway Foundation, financial benefits support, and your District goals. Make your goals SMART (S-specific M-measurable A-agreed upon R-realistic T-timely). Example: Our lodge will have a net membership increase of 5% by the end of 2016. 1. 2. 3. 4. 8 2016 MEMBERSHIP COMMITTEE Please provide the names of your Lodge s Membership Committee. This list will be used for communications purposes only. Chairperson: Email: Telephone: ( ) We hereby certify that this rating form has been reviewed and approved by our lodge officers and to the best of our knowledge has been completed in an objective manner and is an accurate evaluation of our lodge and its activities. Signed: Signed: Date: Date: Have you included your local, regional or national newspaper or magazine articles? Please mail this form to your Zone Director by March 1, 2016. You have completed your work. Tusen Takk! Lodge Achievement Form 2015 7