State Council Service Program Awards Entry Form

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STATE COUNCIL SERVICE PROGRAM AWARDS
ENTRY FORM
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
STSP
11/11

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