2026-27 Rotary District 5520 Assistant Governor Club Visit Form

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Thank you very much for completing this form for every visit with your assigned Clubs.

Your name *

Your e-mail address *

Who is your Lieutenant Governor (Reminder that DGN Mark is serving in this role for the East and DGE Laura is serving in this role for the North)? *

Mike Hackett

George Greenlee

DGN Mark Goodman

DGE Laura Gonzales

Required

What Club did you visit? *

Date of Visit *

YYYY

Type of Visit (Club Meeting, Board Meeting, Service Project, Fundraiser, etc.) *

Was the visit remote (e.g., phone call, Zoom) or in person? *

Remote

In Person

Please rank the overall health of the Club. *

Green - Healthy

Yellow - Some concerns

Red - Needs intervention

What were your observations that led you to the rating above? *

Any Important Events (recently or upcoming) for the Club?

Any items the District can help the Club with?

What is the status of the Club and the three-year Goal Plan from RI? *

1) Goals are in Rotary Club Central (including the 6 RI Priority Goals), and the Club has a plan to achieve the goals.

2) Goals are in Rotary Club Central (but not all 6 of the RI Priority Goals), and the Club has a plan to achieve them

3) Goals are in Rotary Club Central but the Club does not have a plan to achieve them

4) The Club has no goals in Rotary Club Central

If anything other than #1 in the previous question, what is the next step to help the Club with this?

Name any Rotarians in the Club that you think would make great future leaders, either at the Club or at the District level, including serving on a particular District Committee. For each Rotarian you name, briefly describe why you feel this way and if there is a particular District Committee you think they would be a great fit for.

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