PNW CKI District Monthly Report

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Welcome to the District Monthly Report form, created by the Pacific Northwest District of Circle K International! If you are currently a club secretary in the PNW District, our district specifically asks that you complete both the International Monthly Report form, as well as this District MRF.

This form is similar to the International MRF, however, we want to understand your club's accomplishments, problems, solutions, and goals on a smaller scale. This form is dedicated to bridging a stronger relationship between clubs and the district board. We want to be a support system for you, and we cannot do that without your consistent participation and communication.

If you have any questions, comments, or concerns, please contact Lieutenant Governor-at-Large Shane Petrus at shane.petrus@wsu.edu, or visit www.pnw-cki.org today.

Secretary Full Name *

Home Club *

University of Washington - Seattle

Seattle University

Western Washington University

University of Victoria

University of British Columbia

University of Fraser Valley

Saint Martins University

Green River College

Washington State University - Pullman

Linfield College

University of Oregon

University of Portland

Oregon Institute of Technology

Oregon State University

Pacific University

Lewis and Clark College

Email Address *

Phone Number *

Member ID # *

Number of Service Hours Completed *

Number of Interclubs Completed *

Number of K-Family Relation Events *

Service Partners/Charities of the Month *

Average Number of Attendees per meeting *

1-10

11-20

21-30

31-40

41-50

50+

Average Number of Attendees per Service Event *

1-10

11-20

21-30

31-40

41-50

50+

Please explain any goals completed this month *

Please cite any club/officer goals that were accomplished this month. Examples include: service hours, high attendance, officer achievements, etc.

How would you rate your club engagement this month? *

Extremely Low

Very High

How would you rate your club attendance this month? *

Extremely Low

Very High

What is one thing your club wants to improve upon and why? *

Please ensure all information above is accurate.

Please type your full name as a signature. By signing below, you agree that all of the information contained in this form is accurate and up-to-date. If there are any changes to be made to your submission, please contact District Secretary Sruti Nagalla at pnwckidistrictsecretary@gmail.com or Lieutenant Governor-at-Large Shane Petrus at shane.petrus@wsu.edu.

Signature *

Date Submitted *

YYYY

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