Award Forms and Scholarship Applications Can Also Be Found Online At

Ohio District Awards Packet

District Convention 2017

Award forms and scholarship applications can also be found online at

How to Apply

1. Eligibility: A Circle K club must be in good standing with both the Ohio District and Circle K International, and must have submitted at least 9 of the required 12 monthly report forms (MRFs) in order to apply for any awards.
2. Unless otherwise indicated, forms must be completed by Circle K members (not an advisor or Kiwanian) and must be submitted to the Ohio District of Circle K Office.
3. Signature Sheet: A completed signature sheet is required for reward forms to be considered. It is not required, however, for scholarship forms.
4. Electronic Copiesmust be sent to:

MUST BE RECEIVED BY: January 6, 2017 @ 11:59PM

1. Hard Copiescan be sent to:

Ohio District Circle K

941 Chatham Lane, Suite 236

Columbus, OH 43221

MUST BE POST-MARKED BY: January 4, 2017

NOTE: You are not required to fill out the entire packet! You may pick and choose the awards that apply to your club and members.

Table of Contents

• Signature Sheet3

• Club Awards
• Daniel J. Romanello Achievement Award4
• Ken Creasey Most Improved Club Award12
• Kiwanis Family Award13
• Outstanding Scrapbook Award16
• Single Service Award17

• Officer and Committee Chair Awards
• Lanton Lee Outstanding President19
• Outstanding Vice President23
• Linda M. Stiegler Outstanding Secretary26
• Andrew Littlefield Outstanding Treasurer29
• P.A.C.E. Setter32
• Brian Ritchie Outstanding Club Committee Chairperson35

• Member Awards
• David Mathias Outstanding Kiwanis Family Achievement38
• Erin M. Dillon Outstanding New Member41
• Jason Stewart Outstanding Member44
• Tom Andrews Award for Leadership46

• Kiwanis Awards
• James F. Kneisel Outstanding Kiwanis Sponsor Club47
• Kenneth H. Weeks Outstanding Kiwanian50

• Other Special Awards
• Wayne and Laura Enders Ohio Circle of Service Award52

Signature Sheet

In order for any award form to be judged by the District Board, your club must obtain the following six signatures. By signing this form, that person has verified that the material enclosed is correct.

Circle K Club of______

Circle K Club President______

Circle K Club Vice President______

Circle K Club Secretary______

Circle K Club Treasurer______

Faculty Advisor______

Kiwanis Advisor______

Please Note:

The following signatures are required by those who are not elected district board officers. Your club should elect two (2) delegates, one (1) Sergeant-at-Arms and two (2) alternates to serve at Convention.

Delegate #1______

Delegate #2______

Seargeant-at-Arms______

Alternate Delegate #1______

Alternate Delegate #2______

THIS FORM MUST BE ENCLOSED WITH THE COMPLETED AWARD APPLICATIONS IN ORDER TO BE ELIGIBLE FOR AWARDS

Daniel J. Romanello Achievement Award

Award Philosophy: The Club Achievement Award is designed to recognize and honor those Circle K clubs that have excelled in all aspects of club operation.

Guidelines for Form Completion

1. Members reported must be in good standing with both the Ohio District and Circle K International. For your club to be in good standing, you must have no debt to the district or international.
2. Use club minutes, MRFs sent to the district, and other club records to complete each section of the form.
3. Use specific statements showing definite accomplishments, including the month and year in which the activities were conducted.
4. State the exact role of club participation, such as “hosted,” “cooperated,” “aided,” “assisted,” etc.
5. List activities performed by the club as a whole, not those performed by individual members of their own initiative or as members of other school or community groups.
6. If any area or question does not apply to your club, please write “N/A” in the space provided.
7. Review the award submission with the individuals listed on the application and obtain the proper signatures of certification. Failure to do so disqualifies your entry.

DIVISION DETERMINATION

The following will determine the division in which your club will compete. Please add the number of paid members to your club as of February 1, 2016, to the number of paid members of your club as of January 31, 2017. Take the total sum and divide it by two (2) for your club’s total membership average. This is done to compensate for both the paid membership at the end of the ’15-’16 fiscal year and the paid members of the ’16-’17 fiscal year. This award is split by the average memberships of your club, so clubs are being judged with other clubs of similar size.

1. Number of paid members as of February 1, 2016: ______(“membership total 1”)
2. Number of paid members as of January 31, 2017: ______(“membership total 2”)
3. (membership 1) + (membership 2) = ______(“membership total 3”)
4. (membership total 3)/2 = ______(“total membership average”)

According to your Total Membership Average, in which division does your club fall?

Gold Division (40+) Silver Division (26-40) Bronze Division (25 or fewer)

RULES

1. Each Circle K club shall use this standard form for its entry and follow all instructions for this form.

1. Each club must be in good standing with both the Ohio District and Circle K International.

1. Please only include activities undertaken during the time period of February 1, 2016, to January 31, 2017.

1. Part two of this form must be typed.

1. Repetitive reporting of activities, fancy bindings, pictures, etc. will not be taken into account when judging applications.

1. Total service hours for each activity shall be reported by area: planning, travel, project time, and follow-up. A service hour is sixty (60) minutes of work performed by a member of a Circle K club on a service project participated in or approved by the club or club board of officers.

1. Prizes can be awarded to first, second, and third places in each division.

1. The decisions of the judges are final. No changes, alterations, or re-grading will take place after judging is complete and approved by the district board.

Part i: Club Information

1. Circle K Club Administration

Club Meetings

1. How many club meetings were held, described as the following:

a. During the school year that were attended by an advisor_____

b. During the school year that had a guest speaker_____

c. During the holidays or other break periods _____

d. Special meetings (banquets, ceremonies, etc.)_____

e. Board meetings_____

Average club meeting attendance as a percentage of dues paid membership:

(Include all regular club meetings, round to nearest whole number)_____

Club Reports and Public Relations

2. a. How many monthly reports were submitted to the district from February 1, 2016, to January 31, 2017? _____

b. Were articles submitted to the district newsletter?_____

Was article printed in district newsletter?_____

c. Were articles submitted to the CKI magazine?_____

Was article printed in CKI magazine?_____

d. Were articles sent to the campus newspaper?_____

Was an article printed in the campus newspaper?_____

e. Were articles sent to the community newspaper?_____

Was an article printed in the community newspaper?_____

f. Did the club have any publicity through radio or television? _____

Dues Payment: What date was the first payment for fifteen or more members sent to the Circle K International office in 2016? _____

District/Division Involvement

4. Activities in which the club participated:

a. Division rallies_____

b. District Events: Please indicate the number of district events attended by any club members. District events include: District Convention, February 2016; SpOT, April 2016; Fall Rally, October 2016

District Convention_____

SpOT_____

Fall Rally_____

c. Did the club participate in Circle K Week? _____

Club Communications

5. Did the club utilize either of these forms of communications for members?

a. Club newsletter with a minimum of four (4) issues._____

b. Club Web site_____

c. Club directory_____

d. Club e-mail_____

1. Club Membership

Education & Development Programs

1. Did the club provide a special program for new member induction, including a ceremony and pin presentation? _____

2. Did the club provide a formal program for member orientation and education including a CKI 101 program, handbook, etc? _____

Convention Attendance

3. a. Was an advisor in attendance at the District Convention in 2016?_____

b. How many voting delegates attended the District Convention in 2016?_____

c. How many members attended the District Convention in 2016?_____

4. How many members attended the 2016 International Convention in Toronto? _____

Membership Activities

5. How many club social activities were held for all club members?_____

6. How many joint meetings were held with other Circle K clubs?_____

7. How many interclubs did your club attend at other Circle K clubs?

Membership Growth_____

8. What is the % increase in the number of dues paid members from February 1, 2016, to January 31, 2017? (If the number is zero or negative write - N/A for not applicable.) _____

1. Leadership Development

1. Did your club participate in or conduct a formal officer training? (SpOT 2016 is considered formal officer training.) _____

2. Did your Kiwanis sponsor(s) give financial assistance to send club officers to SpOT or did they hold a club training session for club officers themselves? _____

3. Has your club conducted a club officer and/or member leadership retreat?_____

4. Did your club attend Fall Rally? How many members attended?_____

5. Were the following committees active during the year?

a. Service Project Committee_____

b. Fundraising Committee_____

c. Membership Development and Education_____

d. Kiwanis Family Committee_____

6. What percentage of members have served in leadership positions including club officers, committee and project chairs, district and international officers/committee chairs during the past administrative year? _____

7. Has the club had one of the following during the past year?

a. A candidate for District or International office_____

b. A district officer or district committee chairperson_____

c. An International officer_____

d. A Circle K representative to student government

8. Did the club sponsor a leadership program on campus_____

1. Kiwanis Family Interaction

1. How many Circle K meetings have the sponsoring Kiwanis club members attended?

_____

2. How many times did Circle K members attend the sponsoring Kiwanis club’s meetings?

_____

3. How many joint service projects have the Circle K and sponsoring Kiwanis club conducted? _____

4. Has the Circle K jointly sponsored a Builders Club, K-Kids or Aktion Club, with its sponsoring Kiwanis club? _____

5. Has the Circle K club participated in at least one service project with:

a. A Kiwanis club – other than its sponsor?_____

b. A Key Club?_____

c. Builders Club, K-Kids, or Aktion Club?_____

6. Has the Circle K club presented a program at a Builders club, K-Kids or Key Club meeting? _____

7. Has the Circle K club participated in at least one interclub with:

a. A Kiwanis club – other than its sponsor?_____

b. A Key Club_____

c. Builders Club, K-Kids or Aktion Club?_____

1. Service Projects

List service projects (30 max) involving the greatest number of members and service hours the Circle K club has completed between February 1, 2016, and January 31, 2017. The projects should be organized by month. For a recurring project (for example, daily/weekly raising and lowering of school flags) treat the project as a single project for each month.

For each project, provide the month, name of project, number of members participating and number of service hours produced by Circle K members or number of hours completed during the month if the project is recurring.

The list must be a) typed or b) completed as a computer printed document. An example is provided below. Attach the list to this form using a separate sheet of paper.

(Service Project Listing Example)

Project Description Month # Members Service Hours

1. Reading Buddies March 2016 12 48

2. School Trash Pick-up April 2016 17 44

3. Reading Buddies April 2016 18 36

4. Pen Pals with elem. Students May 2016 15 60

5. Bake Sale for United Way May 2016 12 48

1. Service Hours

Total number of members in the club (Use the number calculated on the first page of this report, referenced as ‘total membership average’). Divide the total service hours by the number of members. Please round to nearest full point value. ______%

1. Service Fund-raising

Total the money raised (surplus) by the Circle K club for non-profit, education and other charitable purposes. ______

Divide the $US figure by the number of dues paid members______

Part ii: Service, Leadership, Fellowship And Kiwanis-Family

H. Service Projects

In each of the categories under this section, please describe the project and be sure to include the number of members participating and the total number of service hours performed. No project can be listed under more than one category. These projects may be typed on a separate sheet of paper, titled, numbered and attached to the back of this award form.

•Responses to section H are limited to 3 sides of a typed, 12 pt. font, double-spaced, 8.5x11” page.

1.Give a description of the best service project to the campus.

2.Give a description of the best service project to the community.

3.Give a description of the best joint service project held with your sponsoring Kiwanis club.

4.Give a description of the best joint service project held with any member of the Kiwanis-Family other than the sponsoring Kiwanis club.

5.Give a description of the best joint service project held with another Circle K club.

I. Leadership

Explain how the club developed the leadership potential of its members and club officers outside of district and international leadership events.

•Responses to sections I, J, and K are limited to 1 side of a typed, 12 pt. font, double-spaced, 8.5x11” page.

J. Fellowship

Describe how the club promoted fellowship among its members and other Kiwanis-Family members.

K. Kiwanis-Family Relations

Describe how the club promoted good Kiwanis-Family relations. (Be sure to include any Key to College programs, Kiwanis Career Contacts and Kiwanis-Family events attended).

L. Testimonial

An essay describing how the service your club provided over the past year has impacted your campus and community.

•Responses to section L are limited to 2 sides of a typed, 12 pt. font, double-spaced, 8.5x11” page AND SHOULD BE SIGNED BY THE SUBMITTER.

Ken Kreasey Most Improved Club Award

Dues Paid Members as of February 1, 2016 ______

Dues Paid Members as of January 31, 2017 ______

This award will be given to the Circle K Club that has improved the most over the last twelve-month period, based on improvement in type and number of activities (projects, meetings, interclubbing, etc.) Judging will be based on monthly report forms from the previous year, as well as the previous year’s Daniel J. Romanello Sr. Club Achievement Award application (if available).

If the Club Achievement Award application from the previous year is unavailable, the club president must submit a statement of the initial state of the club as of February 1, 2016.This statement must be signed by the club president, faculty advisor, Kiwanis advisor, and Lieutenant Governor of the club’s division. Monthly report forms from the year prior to the current award form application deadline must be included as well.

All Applicants

Please include a separate essay of no more than 800 words, double-spaced and typewritten by a club member, regarding why your club feels they should receive the Ken Creasey Most Improved Club Award.

Kiwanis Family Award

The Kiwanis Family Award is an effort to promote continued interaction between different Circle K clubs, as well as between Circle K clubs and other branches of the Kiwanis Family, both within the Ohio District and all of Circle K International.

Because the award is intended to promote continued interaction, each Circle K Club is encouraged to repeat objectives as often as possible, and fulfilling certain requirements will result in additional incentives. Repeating objectives will earn the points over again and foster Kiwanis Family interaction.

The Kiwanis Family Award is based on a point system, with each requirement assigned a specific value. Each club should strive to complete as many objectives as possible by January 5, 2017. The clubs with the top three total points will be recognized with awards at District Convention.

In order for an activity to be counted towards completion of the Kiwanis Family Award, at least 3 members from each of the involved clubs must have been present. Clubs with 1-2 members present shall receive half the allotted points.

Objectives

Category 1 (20 points each)

1. Hold a Kiwanis Family service project, incorporating at least one other Circle K club and one club from another branch of the Kiwanis Family
2. Hold a Kiwanis Family social, incorporating at least one other Circle K club and one club from another branch of the Kiwanis Family
3. Attend Fall Rally, SpOT, and District Convention
4. Attend a Builders Club, K-Kids, or Aktion club meeting or project
5. Attend Kiwanis District Convention or Key Club District Leadership Conference

Category 2 (10 points each)

1. Interclub with a Circle K Club outside of your division
2. Attend a Key Club divisional meeting
3. Attend a Kiwanis divisional meeting
4. Attend all divisional rallies in your division
5. Attend at least 10 meetings of your sponsoring Kiwanis Club (only 2 Circle K members need be present at each meeting to fulfill this)
6. Attend a meeting or project of a Kiwanis Club not in your division
7. Attend a project of your sponsoring Kiwanis Club
8. Hold a Kiwanis appreciation function for your sponsoring Kiwanis Club

Category 3 (5 points each)

** Must complete all objectives in this category to qualify for the Kiwanis Family Award**

1. Interclub with a Circle K Club in your division (other than at a divisional function)
2. Participate in a Key Club project or meeting in your division
3. Interclub with a Kiwanis Club other than your sponsoring club

If your club fulfills all objectives in two (2) categories, you will receive an additional 25 points toward your total score. Please fill in your responses to the objectives above on the spreadsheet located on the following page.

SUBMISSION OF THIS FORM IS REQUIRED FOR AWARD CONSIDERATION

Use additional sheets if necessary.

Outstanding Scrapbook Award

Club Permanent Mailing Address:

Official Number of Club Members: ______

Rules:

• Each Circle K Club may enter a scrapbook containing pictures, souvenirs, examples, newspaper clippings, etc. of its activities (both service and social) between the period of the 2016 and 2017 District Conventions.
• The size, be it width or length, is limited to 18x27 inches. In the case of round scrapbooks, the dimensions of the cover are not to exceed 482 square inches. The maximum amount that can be spent on the scrapbook is $300.
• Content and general format of the scrapbook are left to the discretion of the individual club. If a video scrapbook is submitted, notify the Convention Chairperson at least one month prior to District Convention. Scrapbooks may be submitted on DVD.
• The submitted scrapbook must include the following categories and must be tabbed accordingly and included in the table of contents with page numbers:
• Service to Campus
• Service to Community
• Fundraising Projects
• Involvement with Kiwanis Family Projects
• Involvement with the Preferred Charities/Service Partners (including Eliminate)
• Miscellaneous
• Judging of the scrapbook will be based on quality, with regard to:
• General Content (40%)
• Originality (20%)
• Clarity (20%)
• Appearance (10%)
• Form (10%)

ENTRIES FOR THIS AWARD MUST BE SUBMITTED TO THE CONVENTION CHAIRPERSON BY NO LATER THAN MIDNIGHT OF THE FIRST DAY OF DISTRICT CONVENTION