ANNUAL REPORT FORM

Select NLPOA Region*
- West
- East
- North
- South
Please select your Chapter*
Chapter's Official Name (per IRS Records)*
Chapter's Official Mailing Address (per IRS Records)*
Chapter's Official Website*
Employer Identification Number (EIN)*
501(c)3 Active Status:*
- Yes
- No
If No, describe the reason and status:
Describe the most significant events and operations accomplished by the chapter in the past year:*
Chapter Student Scholarships
Number Awarded*
Total Amount*
Total Student Members*
Last year's Chapter Membership Roster
Number of LEOs*
Number of Associates*
Number of Lifetime Members*
Total Members*
Current Chapter Membership Roster (As of right now)
Current Number of LEOs*
Current Number of Associates*
Current Number of Lifetime Members*
Current Total Members*
Please upload your MASTER ROSTER *AND* LATEST MEETING MINUTES
Drop files here or

Accepted file types: xls, xlsx, pdf, doc, docx, Max. file size: 256 MB.
Is your current Dues Paid / Membership Roster? If so, please provide the date of submission, amount, and if paid by CC or Check:*
Chapter Board Most Recent Election Date*
Most Recent Meeting Minutes*
- Yes
- No
President Full Name*
President Email Address*
President Cell Phone*
Treasurer Full Name*
Treasurer Email Address*
Treasurer Cell Phone*
Secretary Full Name*
Secretary Email Address*
Secretary Cell Phone*
Submitted and Signed by (President or Representative with Signature Authority)
Type Name / Title*
Date of Submission*

If you wish to renew via mail, send your check with Annual Report, Member Roster and most recent meetings Approved Minutes to:

NLPOA
PO Box 4449
Ontario, CA 91761

Chapter Student Scholarships