KEY CLUB REPORT FORM
NEW YORK DISTRICT - KEY CLUB INTERNATIONAL

Key Club of ________________________Division______________________
President_____________________________President's Phone # ( )_____________
Number of Members to Date______________________Month of_________________

**Attach additional pages if necessary**
Mail 1 copy to both District Secretary Jane Li and to your Lt. Governor

---

Advocacy

Please attach 1 copy of each letter written
# of different letters___________# of copies of each letter____________

---

Governor's Project - (strictly service)
"Caring in Golden Years... and Sharing in Challenges"

Describe Projects
1.____________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________

Hours Worked x Number of Participants = _______ 2.____________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________

Hours Worked x Number of Participants = _______

---

New York District Projects - fundraising only
(You must attach copy of the check to receive credit)

$Kamp Kiwanis___________________$Kiwanis Pediatric Trauma Center________________
$Iodine Deficiency Disorder_____________________$Local Causes___________________
$March of Dimes________________________________$American Cancer Society_________
$Lupus Foundation___________________________$Make-a-Wish Foundation_____________
$Operation K.I.D., Inc._____________________
$American Foundation for IADS Research (AMFAR)________________________
Describe fundraising method____________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________

---

K-Relations

Describe Project and Name K-Family Members Involved
______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________
# of Participants Home Key Club _____ Other Key Club ____ Circle K ____
K-Kids ____ Kiwanis _____ Builders Club ____

Total Home Club Participants____ x Hours Worked____ = ________

---

Public Relations (Check all that apply, no credit without documentation)

• Newspaper - Date___________________ Number of Articles (attach 1 copy of each) ________
• Divisional/Club Newsletter (attach copy)
• Posters/Fliers # of copies (attach copies)_______________
• Empire Key (attach copy)
• PA System (attach copy of announcement) Date__________
• Keynoter (attach copy)
• Radio/Television - Station:__________ Date of Broadcast______________
  Describe Broadcast_____________________________________________________ _______________________________________________________________________ _______________________________________________________________________
• Other (describe briefly)_____________________________ _______________________________________________________________________ _______________________________________________________________________

---

Theme and Major Emphasis Program - "Children, Their Future, Our Focus"

Describe Project_______________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________
# of Participants______ # of Hours Per Participant______
Man hours (# of Participants x # of Hours Per Participant)________

---

World Wide Service Project (IDD)

Describe Fundraiser and Include the Amount Raised_______________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________

---

Read and Lead

# of Participants_____ Total Hours______ # of children tutored_________
Name of School where project took place________________________________________
Address of School_______________________________________________________ _______________________________________________________

---

Other Projects

Describe other projects your club has participated in_______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________
Total Man-hours for all projects (# of participants x hours worked)____________

---

#of Club Meeting held this month________ # of Faculty Advisors present________ Kiwanians________
Dates and times of meetings_______________________________________________________
Are your meetings productive? Explain. Include where meetings are held.



Are there any problems in your club? Explain.



President's and Faculty Advisor's Signatures _____________________ ____________________