Mem­ber Fra­ter­nal Survey

KofCFormLogo Coun­cil 2179 Annual Fra­ter­nal Survey
Indi­vid­ual Mem­ber Worksheet

Over the last ten years, the Knights of Colum­bus donated more than $1.5 bil­lion to char­i­ta­ble and benev­o­lent causes and more than 682 mil­lion hours of vol­un­teer com­mu­nity ser­vice to aid the less for­tu­nate. To help pre­pare our Fra­ter­nal Sur­vey for the Supreme Coun­cil office, please com­plete the infor­ma­tion requested below and return it at our next meet­ing. This infor­ma­tion will assist us in deter­min­ing the total num­ber of hours of com­mu­nity ser­vice vol­un­teered by our members.

Fra­ter­nal Year: Invalid Input

Member’s Name: Invalid Input

1. Num­ber of vis­its you made dur­ing the year to:
Sick — car­ing for the sick /​nurs­ing homes /​hos­pi­tals (*) Invalid Input
Bereaved — vis­its of con­do­lence (*) Invalid Input
2. Num­ber of times you served as a blood donor dur­ing the year (*) Invalid Input
3. Esti­mated hours of com­mu­nity vol­un­teer ser­vice dur­ing the year:
Church Activ­i­ties — ser­vice in all Church related activ­i­ties (*) Invalid Input
Com­mu­nity Activ­i­ties — ser­vice in all com­mu­nity related activ­i­ties (*) Invalid Input
Youth Activ­i­ties — ser­vice in all youth related activ­i­ties (*) Invalid Input
Habi­tat for Human­ity — ser­vice in all related projects (*) Invalid Input
Cul­ture of Life Activ­i­ties — ser­vice in all related projects (*) Invalid Input
VAVS (*) Invalid Input
Food For Fam­i­lies (*) Invalid Input
Spe­cial Olympics (*) Invalid Input
Mis­cel­la­neous Activ­i­ties — ser­vice in areas not out­lined above (*) Invalid Input
4. Num­ber of hours of fra­ter­nal ser­vice dur­ing the year:
Sick/​disabled mem­bers and their fam­i­lies — house­hold chores, trans­porta­tion, tutor­ing, coun­selling, etc. (*) Invalid Input

Cap­atcha:

Invalid Input