District Governor’s Excellence Award
Complete the form, entering your information below each applicable question. There is space for additional information at the end of the form.

MARK ONLY THOSE ITEMS PERTAINING TO THE REPORTING PERIOD.
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COMPLETING THE FORM
Print a copy for your records. (Click the three bars in the upper right corner and choose the Print option)

Then, click the Submit button to send your report.

If you have questions or need assistance, contact PCC Sharon Parker at s_parker121@msn.com or 440-670-6251.
Email Address *
Club Name *
Zone *
Report Period *
ADMINISTRATION
MEMBERSHIP AND EXTENSION
Any TWO
Check all that apply.
ATTENDANCE AND EXTENSION
Any 2
 Attended Zone Advisory Meeting AT Least 2 of 3 meetings
2017 Officers’ Training School
TWO Club representatives must attend.
Representation in 2017- 2018
ACTIVITIES
At least THREE
Check all that apply.
DONATIONS
(Any TWO prior to the last Zone Advisory Meeting)
Community and/or International, State & District Projects
To be eligible for the Humanitarian Award, 5 International/State/District donations must be made.
PUBLIC RELATIONS
At least TWO of the following
Clear selection
Check all that apply
Total Service Hours
(This reporting period ONLY)
ADDITIONAL INFORMATION
Use this space to list anything not reported elsewhere.
Submit
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