2019-20 NYCKI Election Report Form
Please use this form to list the club officers that will be leading your school's Circle K chapter for the 2019-2020 service year.

If there are any questions or issues filling out this form, please feel free to contact 2019-2020 District Editor Jason Zhao at jason.zhao@nycirclek.org or District Governor Peony Tse at peony.tse@nycirclek.org.

Email address *
General Club Information
College/University *
Club Primary Email Address *
If your club has an email address (such as circlek@school.edu or schoolCKI@gmail.com), please list it here. Otherwise, list your club president's email.
Your answer
Club Website *
If your club does not have a website, type "N/A"
Your answer
Club Social Media Links *
This would include Facebook pages, Twitter, Instagram, Snapchat, etc. If your club does not have any social media links, type "N/A".
Your answer
Club President(s)
Please enter the information for your Club President here. If your club does not have Co-Presidents, you may leave the Co-President's fields blank.
President's Name *
Your answer
President's Email Address *
Your answer
President's Phone Number *
Your answer
Co-President's Name
Your answer
Co-President's Email Address
Your answer
Co-President's Phone Number
Your answer
Club Vice President
Vice President's Name
Your answer
Vice President's Email Address
Your answer
Vice President's Phone Number
Your answer
Club Secretary
Secretary's Name
Your answer
Secretary's Email Address
Your answer
Secretary's Phone Number
Your answer
Club Treasurer
Treasurer's Name
Your answer
Treasurer's Email Address
Your answer
Treasurer's Phone Number
Your answer
Club Editor
Editor's Name
Your answer
Editor's Email Address
Your answer
Editor's Phone Number
Your answer
Club Webmaster
Webmaster's Name
Your answer
Webmaster's Email Address
Your answer
Webmaster's Phone Number
Your answer
Additional Club Officers
If you have additional club officers (including committee chairs), please include each officer's position, name, email address, and phone number below.
Other Club Officer Information
Your answer
Faculty Advisor
Faculty Advisor's Name *
Your answer
Faculty Advisor's Email Address *
Your answer
Faculty Advisor's Phone Number *
Your answer
Kiwanis Advisor
Please enter the information for the advisor from your sponsoring Kiwanis Club here. If you are not sure who from the Kiwanis Club is the advisor (or there isn't a designated advisor), please enter the information for your sponsoring Kiwanis Club's president.
Sponsoring Kiwanis Club *
Your answer
Kiwanis Advisor's Name *
Your answer
Kiwanis Advisor's Email Address *
Your answer
Kiwanis Advisor's Phone Number *
Your answer
Second Sponsoring Kiwanis Club
Your answer
Second Kiwanis Advisor's Name
Your answer
Second Kiwanis Advisor's Email Address
Your answer
Second Kiwanis Advisor's Phone Number
Your answer
A copy of your responses will be emailed to the address you provided.
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