Award Forms and Scholarship Applications Can Also Be Found Online At

Award Forms and Scholarship Applications Can Also Be Found Online At

Ohio District Awards Packet

District Convention 2016

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. Hard Copies must be sent to:

Ohio District Circle K

6161 Busch Blvd. Suite 220

Columbus, OH 43229

MUST BE RECEIVED BY: January 14, 2016

  1. Electronic Copies must be sent to:

MUST BE RECEIVED BY: January 14, 2016 @ 12:01 AM

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 Award14
  • Kiwanis Family Award15
  • Outstanding Scrapbook Award18
  • Single Service Award19
  • Officer and Committee Chair Awards
  • Lanton Lee Outstanding President21
  • Outstanding Vice President26
  • Linda M. Stiegler Outstanding Secretary29
  • Andrew Littlefield Outstanding Treasurer32
  • P.A.C.E. Setter35
  • Brian Ritchie Outstanding Club Committee Chairperson38
  • Member Awards
  • David Mathias Outstanding Kiwanis Family Achievement41
  • Erin M. Dillon Outstanding New Member44
  • Jason Stewart Outstanding Member47
  • Tom Andrews Award for Leadership49
  • Kiwanis Awards
  • James F. Kneisel Outstanding Kiwanis Sponsor Club50
  • Kenneth H. Weeks Outstanding Kiwanian53
  • Other Special Awards
  • Wayne and Laura Enders Ohio Circle of Service Award55

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

Circle K Club of ______

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, including having at least 20 dues-paid members.
  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 pace 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.

PART ONE of this award consists of check-based questions. Please only answer the questions in the space provided. DO NOT PUT ANY MARKINGS IN THE SCORING SECTION. THIS IS RESERVED FOR THE JUDGES’ USE AND ANY UNAUTHORIZED MARKINGS WILL LEAD TO DISQUALIFICATION OF THE FORM

PART TWO of this award consists of essay-based questions.

  • Responses to section H are limited to 3 sides of a typed, 12 pt. font, double-spaced, 8.5x11” page.
  • Responses to sections I, J, and K are limited to 1 side of a typed, 12 pt. font, double-spaced, 8.5x11” page.
  • 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.

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, 2015, to the number of paid members of your club as of January 31, 2016. 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 ’14-’15 fiscal year and the paid members of the ’15-’16 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, 2015: ______(“membership total 1”)
  2. Number of paid members as of January 31, 2016: ______(“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. DO NOT WRITE IN SHADED AREAS. These are for judge use only. For yes or no questions, please place an “X” in the appropriate box following the question.
  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, 2015, to January 31, 2016.
  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

A. Circle K club Administration / Scoring
(DO NOT WRITE IN SHADED AREAS) / Point Totals
(LEAVE BLANK)
Club Meetings / Club Meetings
1. How many club meetings were held, described as the following:
a. During the school year that were attended by an advisor / 1 point for every four mtgs., max 6 pts.
b. During the school year that had a guest speaker / 1 point for every mtg., max 7 pts.
c. During the holidays or other break periods / 1 point for every 2 mtgs., max 5 pts.
d. Special meetings (banquets, ceremonies, etc.) / 1 point for each, max 5 pts.
e. Board meetings / 13 or more is 6 pts.
8-12 is 4 pts.
2-7 is 2pts
Average club meeting attendance as a percentage of dues paid membership:
(Include all regular club meetings, round to nearest whole number) / ___% / 80% or more is 5 pts.
60-79% is 3 pts.
40-59% is 1 pt.
Club Reports and Public Relations / Club Reports & PR
2. a. How many monthly reports were submitted to the district from February 1, 2015, to January 31, 2016? / 11-12 5pts
9-10 1pt
Yes / No
b. Were articles submitted to the district bulletin editor? / If yes 1 pt
Was article printed in district bulletin? / If yes 1 pt
c. Were articles submitted to the CKI magazine? / If yes 2 pts
Was article printed in CKI magazine? / If yes 2 pts
d. Were articles sent to the campus newspaper? / If yes 1 pt
Was an article printed in the campus newspaper? / If yes 1 pt
e. Were articles sent to the community newspaper? / If yes 1 pt
Was an article printed in the community newspaper? / If yes 1 pt
f. Did the club have any publicity through radio or television? / If yes, 2 pts
Dues Payment: What date was the first payment for fifteen or more members sent to the Circle K International office in 2015? / Semester schools: if postmarked by 10-15-15
District/Division Involvement / How many? / District /Division Involvement
4. Activities in which the club participated:
a. Presidents’ Council Meeting(s) / 2 pts each, max 6 pts.
b. Division rallies / 2 pts each, max 6 pts.
c. District Events: Please indicate the number of district events attended by any club members. District events include: District Convention, February 2015; SpOT, April 2015; Fall Rally, October 2015 / 2 pts each, max 8 pts.
d. Did the club participate in Circle K Week? / 2 pts
Club Communications
5. Did the club utilize either of these forms of communications for members? / Yes / No
a. Club newsletter with a minimum of four (4) issues. / If yes, 4 pts
b. Club Web site / If yes, 2 pts
c. Did the club maintain a club directory? / If yes, 2 pts
d. Club e-mail reflector / If yes, 2 pts
Total score for section A of this report. / Total for A section.
B. Club Membership / Scoring / Point Totals
Education & Development Programs / Yes / No / Education & Development Programs
1. Did the club provide a special program for new member induction, including a ceremony and pin presentation? / If yes, 3 pts
2. Did the club provide a formal program for member orientation and education including a CKI 101 program, handbook, etc? / If yes, 3 pts
Convention Attendance / Convention Attendance
3. a. Was an advisor in attendance at the District Convention in 2015? / If yes, 2 pts
(Maximum)
How many?
b. How many voting delegates attended the District Convention in 2015? / 2 pts per voting delegate max 4 pts.
c. How many members attended the District Convention in 2015? / If more than 40% of club, 4 pts
If between 20% & 40% of club, 2 pts
4. How many members attended the 2015 International Convention in Indianapolis? / 1 pt per attendee, max 4 pts
Membership Activities / Membership Activities
5. How many club social activities were held for all club members? / 4 or more, 4 pts
1-3, 2 pts
6. How many joint meetings were held with other Circle K clubs? / 3 or more, 4 pts
1-2, 2 pts
7. How many interclubs did your club attend at other Circle K clubs? / 1 pt each, max 8 pts.
Membership Growth / Membership Growth
8. What is the % increase in the number of dues paid members from February 1, 2015, to January 31, 2016? (If the number is zero or negative write - N/A for not applicable.) / If 25% or more, 4 pts
If between 15-24%, 3 pts
If between 1-14%, 2 pts
Total score for section B of this report. / Total for B section.
C. Leadership Development / Yes / No / Club Officer Training and Development
1. Did your club participate in or conduct a formal officer training? (SpOT 2015 is considered formal officer training.) / If yes, 3 pts
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? / If yes, 2 pts
3. Has your club conducted a club officer and/or member leadership retreat? / If yes, 4 pts
4. Did your club attend Fall Rally? If any members attended, please indicate how many under the ‘yes’ column. / 9 or more members, 4pts.
4-8 members, 3pts.
1-3 members, 2pts.
5. Were the following committees active during the year?
a. Service Project Committee / If yes, 2 pts
b. Fundraising Committee / If yes, 2 pts
c. Membership Education and Development / If yes, 2 pts
d. Kiwanis-Family Committee / If yes, 2 pts
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? / ___% / 40% or more, 4 pts
30-39%, 3 pts
20-29%, 2 pts
10-19%, 1 pt
7. Has the club had one of the following during the past year? / Yes / No
a. A candidate for District or International office / If yes, 1 pt
b. A district officer or district committee chairperson / If yes, 1 pt
c. An International officer / If yes, 1 pt
d. A Circle K representative to student government / If yes, 1 pt
8. Did the club sponsor a leadership program on campus / If yes, 3 pts
Total your score for the C section of this report. / Total for C section.
Kiwanis Family Interaction / Kiwanis Family Interaction / Point Totals
1. How many Circle K meetings have the sponsoring Kiwanis club members attended? / 10 or more, 4 pts
5-9, 3 pts
1-4, 2 pts
2. How many times did Circle K members attend the sponsoring Kiwanis club’s meetings? / 10 or more, 4 pts
5-9, 3 pts
1-4, 2 pts
3. How many joint service projects have the Circle K and sponsoring Kiwanis club conducted? / 5 or more, 5 pts
1-4, 3 pts
4. Has the Circle K jointly sponsored a Builders Club, K-Kids or Aktion Club, with its sponsoring Kiwanis club? / If yes, 3 pts
5. Has the Circle K club participated in at least one service project with: / Yes / No
a. A Kiwanis club – other than its sponsor? / If yes, 2 pts
b. A Key Club? / If yes, 2 pts
c. Builders Club, K-Kids, or Aktion Club? / If yes, 2 pts for each branch, max 6 pts.
6. Has the Circle K club presented a program at a Builders club, K-Kids or Key Club meeting? / If yes, 2 pts
7. Has the Circle K club participated in at least one interclub with:
a. A Kiwanis club – other than its sponsor? / If yes, 2 pts
b. A Key Club / If yes, 2 pts
c. Builders Club, K-Kids or Aktion Club? / If yes, 2 pts
Total your score for the D section of this report. / Total for D section.
E. Service Projects / 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, 2015, and January 31, 2016. 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 reoccurring.
The list must be a) typed or b) completed as a computer printed document. An example is provided below. Total the number of projects and enter the number in the scoring box 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 2015 12 48
2. School Trash Pick-up April 2015 17 44
3. Reading Buddies April 2015 18 36
4. Pen Pals with elem. Students May 2015 15 60
5. Bake Sale for United Way May 2015 12 48 / Each project 1 pt, max 30 pts.
Total your score for the E section of this report. / Total for E section.
F. Service Hours / Hours per member: 1 pt per service hour.
50 points maximum (subject to be raised if deemed necessary)
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.
Total your score for the F section of this report. / Total for F section.
G. Service Fund-raising / $US / $ per member / Scoring / Point Totals
Total the money raised (surplus) by the Circle K club for non-profit, education and other charitable purposes. Enter this figure in the corresponding box to the right.
Divide the $US figure by the number of dues paid members. Enter this figure into the corresponding box to the right. / 1 pt for every $US per member, 20 pts max.
Total your score for the G section of this report. / Total for G section.
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.
  1. Give a description of the best service project to the campus. (20 Possible Points)
  2. Give a description of the best service project to the community. (20 Possible Points)
  3. Give a description of the best joint service project held with your sponsoring Kiwanis club. (15 Possible Points)
  4. Give a description of the best joint service project held with any member of the Kiwanis-Family other than the sponsoring Kiwanis club. (15 Possible Points)
  5. Give a description of the best joint service project held with another Circle K club. (10 Points Possible)
Total your score for the H section of this report.
Total for H section / Point Totals
I. Leadership (50 points possible)
Explain how the club developed the leadership potential of its members and club officers outside of district and international leadership events.
Total for I section
J. Fellowship – 50 Points Possible
Describe how the club promoted fellowship among its members and other Kiwanis-Family members.
Total for J section
K. Kiwanis-Family Relations – 50 Points Possible
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).
Total for K section
L. Testimonial- 50 Points Possible
An essay describing how the service your club provided over the past year has impacted your campus and community.
Total for L section
Overall point total
Entire Report Total

Ken Kreasey Most Improved Club Award

Circle K Club of ______

Dues Paid Membership as of February 1, 2015 ______

Dues Paid Membership as of January 31, 2016 ______

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).

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