Partnership Profile Report with Special Olympics

For the twelve month period ending December 31, 2009

Due by: January 31

Important:

Please report, whether your council is involved with Special Olympics or not.
Please record information to reflect members and their families' participation.
INCLUDE SQUIRES AND 4TH DEGREE ASSEMBLY TOTALS IN THIS REPORT.
Include financial contributions and hours of community service from all Special Olympics programs (i.e. Family Leadership and support", "Invest in a Life", etc.)
UNITS IN THE PHILIPPINES SHOULD REPORT ALL FINANCIAL DATA IN PESOS.
Include your e-mail address in the space provided to ensure you receive a copy for your files. You will also be given the opportunity to print a copy of your form.


Council Number: *
City/Town: *
State/Province: *
Grand Knight's Full Name: *
Grand Knight's Member Number: *
Financial Secretary's Full Name: *
Financial Secretary's Member Number: *
Date (mm/dd/yyyy): *
Council involved in Special Olympics: *	Yes No

I. Volunteer Hours provided by K of C members and their families to Special Olympics throughout the calendar year.
1. State Games/Events:
2. Regional Games/Events:
3. Local Games/Events:
TOTAL VOLUNTEER HOURS:

II. Number of K of C Volunteers at Special Olympics Games and Events.
EVENT-SPECIFIC VOLUNTEERS:
1. State Games/Events:
2. Regional Games/Events:
3. Local Games/Events:
Total Event-Specific:
YEAR-ROUND K of C VOLUNTEERS:
1. State Games/Events:
2. Regional Games/Events:
3. Local Games/Events:
Total Year-Round
TOTAL K of C VOLUNTEERS (Event-Specific and Year-round)

III. Number of Events in which K of C members and families volunteer.
1. State Games/Events:
2. Regional Games/Events:
3. Local Games/Events:
TOTAL EVENTS:

IV. Total Funds Contributed to Special Olympics.
1. State Games/Events:
2. Regional Games/Events:
3. Local Games/Events:
TOTAL CONTRIBUTIONS:

V. New Events Added This Year

VI. Special Olympics Affiliations


Forwarding Instructions: Including your e-mail address allows you to receive a copy of your report via e-mail so that you can forward an electronic copy to any e-mail recipient at a later date. Enter the e-mail addresses you have available (State Deputy and District Deputy). Leave the line blank if you are unsure of the correct e-mail address. You will have the opportunity to print a copy of the form after you submit the form in the next step. Click the "Continue" button to confirm and submit your form.

Yourself (Council Copy):
State Deputy (State Council):
District Deputy: