Chaplain of the Year : Programs : Nebraska Knights of Columbus

Chaplain of the Year Nomination Form

Instructions

Complete this form for your Council's nomination for Chaplain of the Year. Once you click the Send button, a copy of this form will be sent to your Council's Grand Knight or Program Director, the State Faith Director, and the State Program Director.

Chaplain of the Year nominations are due by
End of Day, March 1.

Please provide some general information about your Council and the
contact information for your Grand Knight or Program Director in the section below.

All fields in this section are required for submission.

Council Number (Required)

Please type in your Council Number.

Council Name (Required)

Please type in your Council Name.

District Number (Required)

Please select your District Number from the drop down list.

Council City (Required)

Please type in your Council's Home City.

Grand Knight/Program Director Name

First Name *

Last Name *

Grand Knight/Program Director Email Address

Please type in your Grand Knight's or Program Director's Email Address

Please provide some Personal Data on your nominee.

Information in this section can be found through Member Management (Online) with the assistance of the Grand Knight or Financial Secretary.

This information is required for submission.

Nominee Name

Please type in the name of your nominee.

First Name *

Last Name *

Nominee Address

Please type in the address of your nominee.

Country

Address Line 1 *

City *

State/Province *

Postal Code *

Nominee Phone Number (Required)

Please type in a phone number for your nominee.

Parish Name (Required)

Please type in the name of your Parish.

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Date Joined

Please select a date for when your nominee joined the Knights of Columbus.

Month

Day

Year

Membership Number (Required)

Please provide your nominee's Membership Number.

Please provide, IN FULL DETAIL, the following information regarding your Chaplain of the Year Nomination.

Why does your Chaplain deserve the distinction of being named State Knights of Columbus Chaplain of the Year?
Explain the Chaplain's involvement with your Council, Parish, and Community.
A photo should accompany the Chaplain of the Year Nomination

You may either use the text area provided to add the information or upload a document and/or picture using the upload file option. You may upload up to 5 documents/pictures using this form.

Additional Information is not required for submission, but will be taken into consideration during the awards selection process.

Additional Information

You may Copy & Paste details about your nominee in the space provided below. You may also type directly into the text area below.

Upload Information #1

You may upload up to 5 documents/pictures using the upload options below.

No file selected