*All Copies MUST be attached to receive credit!*

THE OFFICIAL KEY CLUB MONTHLY REPORT FORM 
OF THE NEW YORK DISTRICT IN KEY CLUB INTERNATIONAL

Key Club of:____________________________	President’s Name:____________________________
Division:_______________________________	President’s Phone:____________________________ 
Month of:______________________________	# of Members to Date:_________________________
*Mail one Copy to both District Secretary Danielle Nathan and your Lieutenant Governor
BEFORE the 10th of month for the month previous*
Please also attach any additional paperwork to the back of this form
District Secretary Danielle Nathan	Lieutenant Governor Nicolle Kaufmann
39 Plymouth Street	269 Hillcrest Ave
New Hyde Park, NY 11040	Troy, NY 12180
Advocacy	*Please attach one copy of every letter written
Number of different letters written:_______________________	Number of copies sent in total:_________
Public Relations	*Attach documentation and copies of all that apply
	No credit will be given without documentation*
Check all that apply:
•	Newspaper Articles- Number of Articles:_________	Dates of publication:___________________
•	Division/Club Newsletter- Issue of Division Newsletter:_________ Issue of Club Newsletter: _______________
•	Keynoter Issue:____________
•	Empire Key Issue:____________
•	Posters/Fliers- Numbers of different:____________	Total Number of Copies Distributed:______
•	PA Announcement- Date of Announcement:___/___/___
•	Radio/Television Broadcast- Date of Broadcast:___/___/___	Station:_____________________________
•	Describe Broadcast:_________________________________________________________________________
•	Other (briefly describe):______________________________________________________________________
K-Relations
Project Description: ___________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________
Number of HOME CLUB Participants(____) X Number of hours worked(____) = Total Service Hours ____

Governor’s Project- “Senior Citizens and improving the quality of their golden years.”
*These projects are strictly service hours*
Project Description: ___________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________
Number of Participants(____) X Number of hours worked(____) = Total Service Hours ____
 Project Description: ___________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________
Number of Participants(____) X Number of hours worked(____) = Total Service Hours ____

World Wide Service Project
Describe Fundraiser: (include amount raised) ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Club Name:_______________________  Division:_______________________________ Month: _____________
International Projects and Programs
Describe Fundraiser:	Amount Raised (attack copies of all checks)
(1) _____________________________	$________ for _______________________(what project)
________________________________
(2) _____________________________	$________ for _______________________(what project)
________________________________	
(3) _____________________________	$________ for _______________________(what project)
________________________________ 
(4) _____________________________	$________ for _______________________(what project)
________________________________

New York District Projects	*these Projects are strictly Fundraising and require 
	proof (checks/documentation) for all money raised*
•	Kiwanis Pediatric Trauma Center	$________ for _______________________(project)
•	Kamp Kiwanis	$________ for _______________________(project)
•	Local Causes	$________ for _______________________(project)
•	March of Dimes	$________ for _______________________(project)
•	amFAR (AIDS Research)	$________ for _______________________(project)
•	American  Cancer Society	$________ for _______________________(project)
•	Leukemia and Lymphoma Society	$________ for _______________________(project)
•	St. Jude’s Children Hospital	$________ for _______________________(project)
•	The Lupus Foundation Of America	$________ for _______________________(project)

Major Emphasis Project- “Children- Their Future, Our Focus”
Describe Projects:______________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________
Number of Participants(____) X Number of hours worked(____) = Total Service Hours ____
Other Projects	*Describe projects below and calculate hours*
________________________________________________________________________________________________________________________________________________________________________________________
Number of Participants X Number of hours worked = Total Service Hours ____
K-Family Focus- “Kiwanis and Kids perfectly fit for life together” *Effective October 1st* -Describe Projects below
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Number of Participants X Number of hours worked = Total Service Hours ____
How many meeting have you held this month? General: _______ Officer:________

Date-Time-Location- Number of Faculty Advisors Present- Number of Kiwanians Present
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Are Your Meetings Productive?_________  Explain:__________________________________________________
Are there any problems in your club? _______ Explain:________________________________________________

President’s Signature: __________________________Faculty Advisors Signature: _________________________