State of North Carolina  Knights of Columbus
     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 (CHECK ONE):

CHAPLAIN AWARD

FROM: GRAND KNIGHT:     TELEPHONE NUMBER:
COUNCIL NAME       NUMBER:
LOCATION:     EMAIL:
                       City & State                              

Project Title: 

Date Project Conducted:

(In the space provided below, describe in one sentence the purpose of this activity. This section must be completed.)

Purpose of Activity:
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:                                     

THIS FORM WILL BE EMAILED TO - State Deputy, State Chaplain and sender.
Save Copy to: Council File
STSP 1/2001

Describe project in detail. (Supplementary material must be submitted by mail along with the nomination. Accompanying materials can include letters, testimonials,news clippings, photographs, pamphlets, etc. Do not submit tapes, video-cassettes, display materials, films, etc., as they will not be considered in judging the nomination.)

ATTEST: Signed: ______________________________  
                                      (State Deputy)                                      (Grand Knight)

ENTRY MUST BE RECEIVED BY THE STATE COUNCIL TO BE ELIGIBLE FOR THE COMPETITION

COPY IS EMAILED TO: State Deputy, State Chaplain, and sender