Club counselor request form
Club counselors can support clubs as they ask questions and work through processes designed to make themselves even stronger.

Would you like to receive a visit from your division's club counselor? Complete this short form.

What is your name?
Your answer
What is your primary e-mail address?
Your answer
What is your primary phone number?
(Please include area code)
Your answer
How may we contact you to set up a visit?
Include either email, phone or both.
Required
What is your position in your club?
Which Kiwanis club do you belong to?
Your answer
Which district do you belong to?
Which division within your district do you belong to?
Your answer
Describe why you are looking for a club counselor's support.
Please give as many details as possible. This information will be given to the club counselor.
Your answer
Submit
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