Rotary Club of ______
Name of Activity ______
Date Completed ______
Avenue of Service (check one or more):
Vocational ____ Youth ____ Club ____ Community ____ International ____ Public Image ______
Was This A Joint Project? (Y/N) ______
Brief Description of Activity (please review criteria (www.rotary7610.org) and provide relevant details: How many Rotarians took part? If a joint project, what other clubs? If a fundraiser, how much was raised? If community service, how many people benefited?)
Use this space for your write-up, or use this form as a cover sheet and just attach your write-up.
Note: The awards (except joint project awards) are based on a club’s entire program of activity in one of the avenues of service. You can submit multiple project descriptions one at a time as they occur through the year, if that’s convenient; or near the end of the year, you can write up a summary of everything your club has done in a specific avenue of service (use additional pages as needed). Please don’t mix different “avenues of service” in one report. But do keep in mind that some projects might fit in more than one place. (For example: A fundraiser that gets publicity for Rotary and supports a club’s community service project might be mentioned in club service, public image, and community service!) Either way, your objective should be to paint for the award committee a full picture of what your club has accomplished in that area during the year.
Submitted by (Name) ______
Telephone ______E-mail______
For questions contact: Hank Allen, Awards Chair at or 703-421-0684
Send 2 copies to: Hank Allen, Awards Chair
47772 Scotsborough Terrace
Potomac Falls, VA 20165-5170
All submissions must be received by May 10, 2010. All received forms will be acknowledged by e-mail. Forms may be accompanied by up to two photos; do not submit DVDs, videos, other bulky attachments, or anything you expect to have returned to you. Snail mail is preferred, especially if you include photos.