Lieutenant Governor:

E-mail:

Division(s):

For the month of:

Date:

Area Administrator's e-mail:*

Kiwanis Lt. Gov.'s e-mail:*

*Leave blank if none.
1. Contacts:
List all contacts in each category that you have made this month.
District Board:

Kiwanis:

Clubs:

Circle K/Builders Clubs:

Other:

2. Divisional Rally or Project:
A. Did you hold a rally this month?

If yes, date of rally:

Location:

Number of K-Family members in Attendance:

Guests present:

B. List any other divisional projects, sessions, President's Council meetings, etc.:

C. Future planned division wide events:

3. Personal Evaluation
A. Evaluate your performance in these areas for the past month. Rate yourself
on a scale of 1 to 5, 1 being poor, 3 being average, and 5 being excellent:
Communication: Organization: K-Family Relations: Punctuality: Service Involvement:




Additional Comments:

B. Goals for the month:

Progress on your personal goals set at Lt. Gov. training:

4. Request for Assistance:
Are you having any difficulties that you would like assistance with or would ike to call to the Executive Board's and/or the Administrator's attention? If yes, explain:

5. Lieutenant Governor Club Evaluation:
Use this space to evaluate each of your clubs. (Note: Please make sure to type in the club name field. If you do not, the info will not be submitted)
Club Name:
Evaluation:

Club Name:
Evaluation:

Club Name:
Evaluation:

Club Name:
Evaluation:

Club Name:
Evaluation:

Club Name:
Evaluation:

Club Name:
Evaluation:

Club Name:
Evaluation:

Club Name:
Evaluation:

Club Name:
Evaluation:

Club Name:
Evaluation:

Club Name:
Evaluation:

Club Name:
Evaluation:


If you have questions, please e-mail:
webmaster@pnwkeyclub.org

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Mailing:
A. Send your newsletter only to: Executive Board, Key Club Officers and Kiwanis Officers
B. Send your newsletter and monthly report form to: Executive Board,
Kiwanis Lt. Gov., District Administrators and your Area Administrator.