2021-22 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 2021-2022 service year.

If there are any questions or issues filling out this form, please feel free to contact 2021-2022 District Editor Joan Cheng at joan.cheng@nycirclek.org or District Governor Chelsea Shuren at chelsea.shuren@nycirclek.org.
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Email *
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.
Club Website *
If your club does not have a website, type "N/A"
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".
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 *
President's Email Address *
President's Phone Number *
Co-President's Name
Co-President's Email Address
Co-President's Phone Number
Club Vice President
Vice President's Name
Vice President's Email Address
Vice President's Phone Number
Club Secretary
Secretary's Name
Secretary's Email Address
Secretary's Phone Number
Club Treasurer
Treasurer's Name
Treasurer's Email Address
Treasurer's Phone Number
Club Editor
Editor's Name
Editor's Email Address
Editor's Phone Number
Club Webmaster
Webmaster's Name
Webmaster's Email Address
Webmaster's Phone Number
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
Faculty Advisor
Faculty Advisor's Name *
Faculty Advisor's Email Address *
Faculty Advisor's Phone Number *
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 *
Kiwanis Advisor's Name *
Kiwanis Advisor's Email Address *
Kiwanis Advisor's Phone Number *
Kiwanis Advisor's Address *
Second Sponsoring Kiwanis Club
Second Kiwanis Advisor's Name
Second Kiwanis Advisor's Email Address
Second Kiwanis Advisor's Phone Number
Second Kiwanis Advisor's Address
A copy of your responses will be emailed to the address you provided.
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