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.)
CATEGORY (MARK ONE): CHURCH FAMILY
COMMUNITY CULTURE OF LIFE
COUNCIL YOUTH
FROM: GRAND KNIGHT: __________________________ TELEPHONE NUMBER: ______________
E-MAIL __________________________________________________________________________
COUNCIL NAME _________________________________________ NUMBER: _____________
LOCATION: ______________________________________________________________________
(Town or City) (State or Province)
Project Title: ____________________________________________________________________________
Date Project Conducted: _________________________________________________________________
Purpose of Activity:
(In the space provided below, describe in one sentence the purpose of this activity. This section must be completed.)
Number of council members participating in project: . . . . . . . . . . . . . . . . . . . . ______________
Percentage of council members participating in project: . . . . . . . . . . . . . . . . . . ______________
Number of man hours expended in project: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ______________
Chairman’s Name: _________________________________ Telephone Number:
Mailing Address: ____________________________________________________________________
E-mail Address: _____________________________________________________________________
(continued on reverse)
MAIL ORIGINAL TO: State Deputy or State Program Director
COPY TO: Council File
Available in electronic format at www.kofc.org
STSP 11/11
STATE COUNCIL SERVICE PROGRAM AWARDS
ENTRY FORM
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