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Entry Form
Jurisdiction: ___________________________________________________ Date: _________________
Instructions
Local Councils: To enter your “Family of the Year” into state/provincial competition, com-
plete this form and forward it to the state deputy.
Additional paper may be used if space allo-
cated is not sufficient. Photographs, news clippings, letters of commendation or other special
exhibits may be included.
Note: individual jurisdictions set their own deadlines for
state/provincial competitions, so watch for deadline dates or contact the state deputy.
State Council:
Select one entry to honor as state/provincial “Family of the Year.” Submit that entry
form, with the state deputy’s signature and all collateral material, to the Supreme Council
Department of Fraternal Services by
June 10 for consideration in the International “Family of the
Year” competition.
A. Personal Data
Member’s Name: ___________________________________________ __________________________
Membership Number
Wife’s Name: ______________________________________________
Children/Ages: Children/Ages:
_________________________________________ _________________________________________
_________________________________________ _________________________________________
_________________________________________ _________________________________________
_________________________________________ _________________________________________
Home Address: ____________________________________________
Home Telephone: _________________________ Business Telephone: _________________________
Parish: __________________________________ Pastor: _____________________________________
Address: _______________________________________________________________________________
Telephone: _____________________________________________________________________________
B. Knights of Columbus Data
Family nominated by Council ________________________ in __________________________________
(Number) (Location)
For how many years has husband/father been a member of the Knights of Columbus?
_______________________________________________________________________________________
Positions (offices/program directorships/chairmanships/committee assignments) held:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
REFER TO THE “FAMILY OF THE YEAR” SELECTION GUIDELINES ON PAGE 2. CONTACT YOUR
STATE COUNCIL OFFICE OR STATE PROGRAM DIRECTOR TO DETERMINE THE
DEADLINE FOR ENTERING THE STATE COUNCIL CONTEST.
FAMILY
of the
YEAR
