Date New Club Number New Club Name Date Organized
Sponsor Club Number Sponsor Club Name
Representative
Name Title Phone
District Representative
Name Title Phone
30 Days
Speaker/Program:
Please rate the general reaction to the speaker/program.
(Poor) q 1 q 2 q 3 q 4 q 5 (Excellent)
Additional comments:
60 Days
Speaker/Program:
Please rate the general reaction to the speaker/program.
(Poor) q 1 q 2 q 3 q 4 q 5 (Excellent)
Additional comments:
90 Days
Speaker/Program:
Please rate the general reaction to the speaker/program.
(Poor) q 1 q 2 q 3 q 4 q 5 (Excellent)
Additional comments:
To be completed for certification:
Two charter officers attend a District meeting or District Convention q Yes q No
Assist the New Club in planning at least one service project? q Yes q No
Club Service Project
Please rate the effectiveness of the Club’s first service project.
(Not Effective) q 1 q 2 q 3 q 4 q 5 (Very Effective)
Assist the New Club in planning at least one fund raising project? q Yes q No
Fund Raising Project
Please rate the effectiveness of the Club’s first fund raising project.
(Not Effective) q 1 q 2 q 3 q 4 q 5 (Very Effective)
Rate the general interest of the Club’s membership and the performance of the officers.
(Poor) q 1 q 2 q 3 q 4 q 5 (Excellent)
Additional comments:
New Club Follow-up Report
Were all new members given orientation? q Yes q No
Has the Club become incorporated? q Yes q No
Secretary/Treasurer completed set-up of records? q Yes q No
Club adopted an annual budget q Yes q No
Club e-mail set-up q Yes q No
Have Club Officers successfully logged onto Optimist Leaders? q Yes q No
Secretary collected and added online Club Members e-mail addresses?
q Yes q No