State Council Family Of The Year Awards Entry Form
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1
2FAMILY
Entry Form
Jurisdiction: ___________________________________________________ Date: _________________
of the
Instructions
YEAR
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:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
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