Lieutenant Governor Report

Lieutenant Governor Monthly Report Form

Name(Required)

Division(Required)

Month(Required)

List names of Kiwanis Family Members you communicated with this month and details of your communication(Required)

What forms of communication did you use with your division this month?(Required)

E-mail

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In Person Visit

Phone Call

Virtual Meeting

Social Media Post

Social Media DM

Did you include your Zone Administrator(s) on all correspondence sent to your division this month?(Required)

Yes

Did you include the executives on all correspondence sent to your division this month?(Required)

Yes

When and where will your next DCM be held?(Required)

Personal Evaluation(Required)

Excellent	Good	Fair	Did not perform up to my ability

Please rate your effectiveness with meeting your goals and completing your tasks this month.

Why did you choose this rating?(Required)

Are there any areas where you can grow and improve? If so, explain briefly.

How have you been active in your home club and/or with service?(Required)

Is there an outstanding club member that you would like to nominate for recognition? What makes this member deserving of recognition by the district? Is there a specific project or event that the member did to deserve this nomination? Please provide as much information as possible. Include the member's full name, club, and e-mail address.

Is there an outstanding club officer that you would like to nominate for recognition? What makes this officer deserving of recognition by the district? Is there a specific project or event that the officer did to deserve this nomination? Please provide as much information as possible. Include the officer's full name, club, position, and e-mail address.

Is there a club that you would like to nominate for Key Club of the Month? What makes this club deserving of Key Club of the Month? Is there a specific project or event that the club did to deserve this nomination? Please provide as much information as possible.

Do have any photos to support any of these nominations?

Max. file size: 100 MB.

Do you feel like the board is an inclusive environment? If not, what can we do to better serve you and ensure that you feel safe and included on the board?

Are there any clubs in your division having difficulties or needing support? If yes, please briefly explain. Is there anything you need help with?

Are there any clubs that you do not have any contact with? What steps are you taking to change this?

Do you have any questions pertaining to your role as Lieutenant Governor?

Have the executives been fulfilling your needs and assisting you in your duties? Please add at least one (1) suggestion you would like to see done to improve.

Has your zone administrator been fulfilling your needs as a Lieutenant Governor?

Are there any topics that you would like to receive more information about? i.e. Governor’s Project, Leadership Training, Global Leadership certificate etc.

Add a picture from your division

Max. file size: 100 MB.

Club Visitations

Did you visit any clubs this month in person or virtually? If yes, please answer the following for each club visit: Club Name * Approximately how many members in attendance * Any non-Key Clubbers in attendance – ie guests or advisors * Purpose of the visit * Is the club functioning well as a Key Club? Any concerns you may have?

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Lieutenant Governor Report

Lieutenant Governor Monthly Report Form

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