Lt. Governor Report Form

If you do not receive a copy in your e-mail in one (1) day, please contact the Technology Chair.

Must be submitted by the 15th of each month.

Please indicate who you would like to send a copy
of this form to by entering their full email address.
(Separate multiple email addresses with commas).

Copies of this report will automatically be sent to:
• The Ltg Completing This Form
• Your Regional Advisor
• District Administrator
• District Governor
• Optional email addresses entered above.

 

LIEUTENANT GOVERNOR
IDENTIFICATION
First Name:
Last Name:
Report Month:
Report Year:
Your Division:
Your Region:
 
TROUBLED CLUB INFORMATION
CLUB 1
Club Name
Have You Contacted?
 The Club
The Kiwanis
 The School
The Regional Advisor
Do you recognise
the problem?
Action Taken
What outside help
is needed?

TROUBLED CLUB INFORMATION
CLUB 2
Club Name
Have You Contacted?
 The Club
The Kiwanis
 The School
The Regional Advisor
Do you recognise
the problem?
Action Taken
What outside help
is needed?

 

NEW CLUB BUILDING
INFORMATION
1. Club Name
Step
New Club Building Comments?

 

CONTACT AND
COMMUNICATION
Have you held a divisional meeting this month?
If so, give a report on attendance and business conducted:
Have you met or contacted your regional advisor this month?
If so, in what form?
Have you communicated with the members of the District Committee on which you serve?
If so, in what form?

 

INDIVIDUAL CLUB EVALUATION
AND CONTACT SUMMARY
1. Key Club Name
Club contact
Kiwanis contact
Iolian—Keynoter
Tasks and Participation
 Report
Interclub
Participated in District Project
Outstanding club project
Rating
2. Key Club Name
Club contact
Kiwanis contact
Iolian—Keynoter
Tasks and Participation
 Report
Interclub
Participated in District Project
Outstanding club project
Rating
3. Key Club Name
Club contact
Kiwanis contact
Iolian—Keynoter
Tasks and Participation
 Report
Interclub
Participated in District Project
Outstanding club project
Rating
4. Key Club Name
Club contact
Kiwanis contact
Iolian—Keynoter
Tasks and Participation
 Report
Interclub
Participated in District Project
Outstanding club project
Rating
5. Key Club Name
Club contact
Kiwanis contact
Iolian—Keynoter
Tasks and Participation
 Report
Interclub
Participated in District Project
Outstanding club project
Rating
6. Key Club Name
Club contact
Kiwanis contact
Iolian—Keynoter
Tasks and Participation
 Report
Interclub
Participated in District Project
Outstanding club project
Rating
7. Key Club Name
Club contact
Kiwanis contact
Iolian—Keynoter
Tasks and Participation
 Report
Interclub
Participated in District Project
Outstanding club project
Rating
8. Key Club Name
Club contact
Kiwanis contact
Iolian—Keynoter
Tasks and Participation
 Report
Interclub
Participated in District Project
Outstanding club project
Rating
9. Key Club Name
Club contact
Kiwanis contact
Iolian—Keynoter
Tasks and Participation
 Report
Interclub
Participated in District Project
Outstanding club project
Rating
10. Key Club Name
Club contact
Kiwanis contact
Iolian—Keynoter
Tasks and Participation
 Report
Interclub
Participated in District Project
Outstanding club project
Rating
11. Key Club Name
Club contact
Kiwanis contact
Iolian—Keynoter
Tasks and Participation
 Report
Interclub
Participated in District Project
Outstanding club project
Rating
12. Key Club Name
Club contact
Kiwanis contact
Iolian—Keynoter
Tasks and Participation
 Report
Interclub
Participated in District Project
Outstanding club project
Rating
13. Key Club Name
Club contact
Kiwanis contact
Iolian—Keynoter
Tasks and Participation
 Report
Interclub
Participated in District Project
Outstanding club project
Rating

 

COMMENTS AND
CONCERNS
Please enter any general comments or concerns

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Copyright 2008 Illinois Eastern Iowa District of Key Club International. Questions or Comments contact the Technology Chair.