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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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, briefly describe the purpose and goals of this program. This 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
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State Council
Service Program Awards
Entry Form
