Single Service Award
The entry must be sent in by March 1, 2019.
Email address *
Key Club of: *
Club ID #: *
District: *
Number of members in club: *
Total service hours involved: *
Project name: *
Contact name: *
E-mail: *
Phone number with area code: *
Application return address: *
City: *
State/province: *
Postal code: *
Country: *
Brief description of project: *
Club membership 1. Enter the total number of dues paid club members as of February 1, 2017. 2. Enter the number of paid members in the box below. 3. Use the number in the box to determine the club’s membership category. 4. Place a check next to the category that applies *
This certifies that we, the undersigned, have read this report and that the activity described in this report and preparations forthis report were performed by official Key Club members. NOTE: All signatures are required. Signatures from the school representative andthe Kiwanis club representative must not be by the same person.
Kiwanis/faculty Advisor: *
Principal: *
Attach Your Project Here *
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