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ICC Life Program Award Application

ICC Life Program Award Application

Instructions

Complete this form for each program that you would like to have considered for a Life Supreme or State Service Award. 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 Life Directors, and the State Program Director.

Some programs may be placed in different categories for award consideration based on Director's discretion.

ICC Award Applications 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.

Please type in your Council Number.
Please type in your Council Name.
Select your District Number from the drop down list.
Please type in your Council's Home City.
First Name *
Last Name *

Please provide a Program Name in the section below.

A Program Name is required for submission.

Program Name
Please select your program from the list below. You will only be able to select 1 activity per application submitted. There is an "Other" option if your program is not listed.
If you selected "Other", please provide a name for your program by typing it in the box below.

Please provide some details about your program in the section below.

Responses in this section are not required, but will be taken into consideration during the awards selection process.

Select both a start and end date for your program. You will be able to select the same date if your program was a single day program.
Start Date
–
End Date
Please provide the number of Members who volunteered for this program.
Please provide the number of Non-Members who volunteered for this program.
Please provide the number of volunteer hours (PER PERSON) for this program
Provide the total cost to your council for planning this program.
Please provide the total number of hours dedicated to planning this program.
Please provide the total number of Participants (Non-Volunteers) who participated in this program.
Please provide the number of new members recruited at your program.
Please provide the amount of donations received from your program.
Was your Pastor/Chaplain present? Please select an option from the drop down list.
On a scale of 1 to 5 (with 5 being the highest) how engaged was your parish, council, and/or community by this program? Please select a number from the list.

Please provide any additional program information you would like to share about your event.

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

You may Copy & Paste details about your program in the space provided below. You may also type directly into the text area below.
You may upload up to 5 documents/pictures using the upload options below.
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