THIS REPORTING FORM MUST BE COMPLETED BY EACH COUNCIL AND FORWARDED TO THE STATE COUNCIL.
(A separate reporting form should be completed for each program category.)
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(continued on reverse)
CATEGORY MARK ONE:
FAITH
FAMILY
COMMUNITY
LIFE
COUNCIL INFORMATION:
COUNCIL NUMBER: ___________________ TOTAL COUNCIL MEMBERS: __________
GRAND KNIGHT: __________________________________ E-MAIL: ________________________________
PROJECT INFORMATION (
complete all sections):
PROJECT TITLE: _________________________________________ PROJECT DATE: ____________________
Participation: __________ + __________ = ____________ ____________ x ___________ = ______________
Members Non Members Total Participants Total Participants Hours Total Volunteer Hours
Program Planning: ___________ & ___________ Members Recruited: _________ Donations: ___________
Costs Time Local Currency
Describe project in detail. Use additional paper if necessary. Supplementary material may be submitted along with the nomination. Accompanying
materials can include letters, testimonials, news clippings, photographs, pamphlets, etc. Do not submit tapes, videocassettes, DVD’s, display
materials, films, etc., as they will not be considered in judging the nomination.
3a) In the space provided below, briey describe the purpose and goals of this program. is section must be completed.
DO NOT SUBMIT THIS REPORT FORM TO SUPREME COUNCIL
ENTRY MUST BE RECEIVED BY THE STATE COUNCIL
TO BE ELIGIBLE FOR THE COMPETITION
MAIL ORIGINAL TO: State Deputy or State Program Director
COPY TO: Council File
Available in electronic format at www.kofc.org
STATE COUNCIL
SERVICE PROGRAM AWARDS
ENTRY FORM
1
2
3
0
0
STSP 11/18
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3b) Whom does this project benefit?
3c) What problem or need did this project resolve?
3d) Why did the council select this project?
3e) Describe the success of the project:
Attest: ____________________________________________
State Deputy
Signed: ____________________________________________ _______________
Grand Knight Date
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