Jurisdiction: ________________ District Number: __________________________________
Degree Date: ________________ Host Council Number: _____________________________
Submitted by: _______________________________________________________________
Title: _______________________________ Membership #: __________________________
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
Location:      
 Church      
 Council Chamber      
 Other
 Admission/1st Degree Team Council: _______________________________________
 Formation/2nd Degree Team Name: ________________________________________
 Knighthood/3rd Degree Conferring Officer Name: ______________________________
Honoree (If Designated): _______________________________________________________
Total Number of Candidates: ___________________________________________________
Length of Degree: ____________________________________________________________
Candidate Details (for Exemplification of Charity, Unity and Fraternity only)
New Members: _____ Priests: _____ Online Members : _____ Advancing Members: _____
Total Observers: _________________
Participating Councils – New Members Only
Council New Council New Council New
Number Members Number Members Number Members
_________ _________ _________ _________ _________ _________
_________ _________ _________ _________ _________ _________
_________ _________ _________ _________ _________ _________
_________ _________ _________ _________ _________ _________
General Observations: ________________________________________________________
________________________________________________________________________________
Send To: ceremonials@kofc.org
cc: State Deputy
State Ceremonial Chairmen
450 10/20
Degree Exemplification
Report Form