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Signer Role:
IP Address:
Language:
Fraternal Programs Report Form
Reporting Officer Name
Membership Number
Council Number
State / Province
Faith
Into the Breach
Marian Icon Prayer
Build the Domestic Church Kiosk
Rosary
Spiritual Reflection
Holy Hour
Sacramental Gifts
RSVP
Other
Family
Family of the Month
Keep Christ in Christmas
Family Fully Alive
Family Week
Consecration to the Holy Family
Family Prayer Night
Good Friday Family Promotion
Food for Families
Other
Community
Disaster Preparedness
Free Throw Championship
Soccer Challenge
Helping Hands
Catholic Citizenship Essay Contest
Coats for Kids
Global Wheelchair Mission
Habitat for Humanity
Other
Life
Christian Refugee Relief
Silver Rose
Pregnancy Center Support
Novena for Life
Mass for People with Special Needs
March for Life
Special Olympics
Ultrasound
Other
If Other, Program Name:
Date(s) of Program :
to
Volunteers:
Members
+
Non Members
=
Total Volunteers
Total Volunteers
x
Hours (Per Person)
=
Total Volunteer Hours
Participants (Non-Volunteer):
Was your Pastor present?
Yes
No
Program Planning:
Costs
&
Time (Hours)
Members Recruited:
Donations:
Local Currency
Icon Number (see icon bag):
Total number of prayer services:
Total coats distributed:
Number of Wheelchairs Funded:
Amount Donated to the Global Wheelchair Mission:
Containers Purchased:
Did your council conduct a Fundraiser/Wheelchair Sunday?
Yes
No
Did your council participate in distribution?
Yes
No
Total amount donated to Habitat for Humanity this year:
Name of Event:
Location of event attended:
(City & State)
Type of Event:
Location Type:
Number of buses chartered/sponsored:
The deadline for submissions is the 15th day of the following month. Example: November nominations need to be received no later than December 15th.
Name of Nominee - Husband:
Number of Kids (if applicable):
Name of Nominee - Wife:
Number of Grandkids (if applicable):
Knights of Columbus Member?
Yes
No
Membership Number (If applicable):
Primary Email Address of Grand Knight:
Month of Nomination:
Primary Mailing Address of Nominee Family:
Address Line 1
Address Line 2
City
State / Province
Zip Code
Country
Please explain the reasons your council selected this family. (Refer to #1993 - Family of the Month/Year - Guidebook for official selection guidelines.)
250
/250 Characters Limit
Is this a State Council Submission? (If yes, numbers on form should represent State Council events ONLY, not a cumulation of jurisdiction activity)
Yes
No
Total Number of Special Olympics Events Supported:
Distance Traveled to Transfer Rose (MI/KM):
Your Grand Knight must complete Form # 2863 for council refund.
Your Grand Knight must complete Form # 10057 for council refund.
Forms #10715 and #10716 must be completed for this program.
On a scale of 1-5 (with 5 being the highest) how engaged was your parish and council by this program?
What information or feedback would you like to share about your program? (To share more success stories, visit kofc.org/knightsinaction)
300
/300 Characters Limit
Submit
Submit Additional Program
