Professional Documents
Culture Documents
CALL
TO
CONVENTION
Dear Key Clubbers of the Kentucky-Tennessee District,
It is my honor and pleasure to invite all of you to attend the 2015 K-T District Convention, March
2022, at the MarriottGriffin Gate Hotel in Lexington, Kentucky. We will be jumping into a
weekend full of activities. Our theme isdrum roll please--- Serve-ivor. Come prepared to
laugh with our Keynote speaker, elect our new 2015-16 District Board, learn new information in
workshops, mingle with Key Clubbers from the district, show off your dance moves, perform in
the talent show, receive well-deserved awards, and more!
Patrick Maurer will be our Keynote speaker this year. Patrick is a former Key Club Governor from
California and graduate of Arizona State University in Phoenix. Patrick has entertained thousands
across North America by combining entertainment with true-life stories to give an important
message. Make sure to check out his video on our district website www.ktkey.org.
We will have important business to take care of as we elect new district officers to lead our
district through 2016. There are many educational and motivational workshops, where you will
gather knowledge and enthusiasm to take back to your home club and schools. The annual
talent show will showcase great talents, and the District Dance is always a favorite to let out your
dance moves and have fun.
You will also have the opportunity to display your clubs service activities at the Service Fair.
Hotel space allows your clubs display to be seen in our convention area the entire weekend to
show off your project. There will also be free time Saturday afternoon for you to enjoy the many
attractions in the Lexington area or to just rest.
Last, but certainly not least, you will make friends and create memories that will last a lifetime.
This exciting weekend will be the highlight of your Key Club year. We invite and encourage you
to come and make the most of all this convention has to offer. It will be an enjoyable,
beneficial, and memorable weekend.
I hope that your club will make plans now to attend this exciting convention in a city known for
its horses, basketball, and hospitality - Lexington, Kentucky. See ya there!
On behalf of The K-T District Board,
Madeline Potter
Kentucky-Tennessee District Governor
$____________________
$____________________
$____________________
$____________________
$___________________
$___________________
$___________________
K-T District Key Club Convention
Steve Phillips
P.O. Box 188
Flintstone, GA 30725
For more information, contact Steve Phillips at 423-508-4885, e-mail sphillips5@aol.com, 706-820-7158 (fax).
6)
7)
Rooming List
Key Club of _________________________________________HS in _______________________________________
We will arrive on______________at__________________
Date
/
Time
unless special arrangements are made.
The hotel will make every effort to have rooms ready. However, normal check in time is 4 pm.
In student rooms with less than four (4) persons do you wish for the
convention committee to place students from other schools in the room?
Yes_____ No_____
*I can only room high school students with other high school students
*ADULTS ARE RESPONSIBLE FOR FINDING THEIR OWN ROOMMATES. Therefore, For adult rooms,
you must pay the rate based on the number of names you are listing in the room with this registration.
*KIWANIS INTERNATIONAL GUIDELINES FOR ADULTS state, .EXCEPT FOR A PARENT
SHARING A SLEEPING ROOM WITH A CHILD, NO ADULT SHOULD SHARE A .SLEEPING ROOM
WITH A YOUTH.
Please observe this policy as you prepare your rooming list.
Room 1 (female, male, chaperone, bus driver)
1._____________________________________
1._____________________________________
2._____________________________________
2._____________________________________
3._____________________________________
3._____________________________________
4._____________________________________
4._____________________________________
1._____________________________________
1._____________________________________
2._____________________________________
2._____________________________________
3._____________________________________
3._____________________________________
4._____________________________________
4._____________________________________
1._____________________________________
1._____________________________________
2._____________________________________
2._____________________________________
3._____________________________________
3._____________________________________
4._____________________________________
4._____________________________________
1._____________________________________
1._____________________________________
2._____________________________________
2._____________________________________
3._____________________________________
3._____________________________________
4._____________________________________
4._____________________________________
As authorized person for our school, I certify that the students registered represent our Key Club. I also certify that the adults registered
are approved by the school, and are cleared to work with, and chaperone young people on overnight trips. All registered adults meet
Key Club chaperone criteria as described on the reverse side of this form. I further certify that at least one (1) designated chaperone is
registered for and is accompanying the students to the convention.
_________________________________________________
Signature of Faculty Advisor or School Principal
Height_____
City
Weight_____
State
Zip
Sex_____Birthday________________
Phone (W)
Alternate Contact_______________________________________________________________________________
Name
Relationship
Phone
Asthma
____
Diabetes
_____
Allergies to medications _____
List any alleries or other medical conditions we need to be aware of: _________________________________
________________________________________________________________________________________________________
I am the parent or legal guardian for the above-named Key Club member, and give my permission for him/her to attend
the convention, conference and/or other event(s) sponsored by the Kentucky-Tennessee Key Club District and Key Club
International. I understand that photos will be taken at convention, and that my childs image may appear in a photo
used to report on this event and/or to promote future Key Club events. I also have read and understand the Code of
Conduct, and I understand that a violation of certain provisions of these rules may result in the dismissal of my Key Club
member from the event. I hereby certify that the information provided above is correct.
In the case of medical emergency, I understand that every effort will be made to contact the emergency contacts listed
above. In the event those persons cannot be reached or time does not permit, I hereby give permission to a licensed
physician or other licensed medical provider, to provide proper treatment, including but not limited to hospitalization,
injection, anesthesia and/or surgery, for the above-named Key Club member. On behalf of myself and my ward/minor,
I/we hereby RELEASE, WAIVE AND FOREVER DISCHARGE the Kentucky-Tennessee Key Club District and Key
Club International and its officers, directors, employees, parents and subsidiaries, agents, from any and all claims,
liabilities, causes of actions, damages, demands, judgments, executions, liens and costs whatsoever, in law or equity,
including, without limitation, liability for death or bodily injuries to any person or damage to any property resulting from
any (i) claims made against medical providers of emergency services under this authorization, or (ii) against Key Club
International for obtaining medical emergency services for said Key Club member pursuant to this authorization.
Parent or Guardian______________________________ Signature____________________________ Date__________
Leadership Conference
March 20-22, 2015
Lexington, Kentucky
Marriott Griffin Gate
Tentative Agenda
Friday, March 20
7pm
9pm
10pm
11pm
12mn
Patrick Maurer
Saturday, March 21
7:30am
Advisors Appreciation Continental Breakfast
Talent Tryouts
8am
Oratorical Contest
Impromptu Essay Contest
9am
Workshop Session II
10:15am
Mixer Session and Service Project
12:30 7pm
FREE TIME
7pm
K-T Recognition Session and Talent Night
8:30pm
Caucus Session II
9:30pm
District Dance
12mn
Curfew
Sunday, March 22
8am
9am
10:30am
12noon
Non-Denominational Devotion
House of Delegates Session
Governors Farewell Brunch
District Board Meeting (Old and New Board Members)
Service
Fair!
To reserve a table for your clubs
display, please contact Acacia Tribell
by Saturday, March 14th, 2015.
Contact Information:
Acacia Tribell
District Historian
acacia-camille-tribell@hotmail.com
Expectations
1. All attendees are expected to abide by all government laws and regulations.
2. Care should be taken not to deface or destroy any property. Such things as pillow
fights, throwing objects from windows or balconies, and affixing materials to hotel
walls are prohibited. In such cases, the school and sponsoring Kiwanis Club will be
notified.
3. The individual member, or club, will be responsible for the cost of any theft or
damage of hotel property.
4. Tobacco products are strictly prohibited at all times.
5. Any intoxicant of any nature will not be permitted in the possession of anyone
attending the convention. This includes, but is not limited to, alcoholic beverages
and controlled substances.
6. No prescription medication shall be permitted unless prescribed to the attendee.
7. Members are expected to abstain from any activity of a sexual nature, including
distasteful dancing and public displays of affection.
8. Members are expected to abstain from hazing or any action that creates
unnecessary physical or mental discomfort, embarrassment, harassment, or
ridicule of others.
9. All participants are expected to attend all convention activities including general
sessions, workshops, and caucuses.
10. Gambling, use of fireworks, or anything of a dangerous nature is prohibited. In
short, any act unbecoming of a Key Clubber will not be tolerated, and may result
in your dismissal from the convention.
Lodging
1. Members must sleep in their assigned rooms.
2. No members of the opposite sex will be allowed in any hotel room occupied by a
Key Clubber unless an adult chaperone is present.
3. At 12 midnight (curfew), each registrant is to be in his or her room, with any
adjoining doors and/or balcony doors closed and locked. Unnecessary noises are
prohibited at any time. Curfew is in effect until 5 A.M.
4. One Kiwanis sponsor, faculty advisor, or adult chaperone (as defined by Key Club
International and approved by the school administration) must register, reside,
and attend the convention for every 4-8 Key Clubbers registered.
Dress Code
1. All participants are expected to adhere to the designated dress code for every
session.
2. Professional dress includes the following:
MalesDress Shirt, Slacks, Neck Tie, Sports Coat or Suit Coat, and appropriate
shoes.
Females-Dress or Suit, Skirt or slacks, blouse, and appropriate shoes
No sleeveless tops are to be worn without an appropriate cover
No midriffs
No shorts, jeans, or tennis shoes will be permitted for males or females.
3. Business casual dress refers to the following:
Males-slacks, collared shirt, and appropriate shoes
Female-slacks, skirt or skort, blouse or collared shirt, and appropriate shoes
No sleeveless tops are to be worn without an appropriate cover
No midriffs
No shorts, jeans, or tennis shoes will be permitted for males or females
4. Casual dress refers to the following:
Males-Appropriate shorts or jeans, collared shirt, sweatshirts, or appropriate shirts,
casual footwear
Females- Appropriate shorts, skirt, skort, or jeans, collared shirt, sweatshirts, or
appropriate shirts and casual footwear.
* Leggings or yoga pants cannot be worn unless they are covered with an
appropriate (fingertip) length long shirt or preferably an appropriate length
dress They CANNOT be worn with a regular top or shirt.
All clothing for males and females must be modest and appropriate
5. No sleepwear of any kind (sleep pants or shorts, pajamas, etc.) is to be worn
in any public area outside of the individuals sleeping room.
6. Nametags are to be worn at all convention activities, but are to be removed
when exiting the convention site.
7. Clothing with inappropriate language or graphics will not be allowed. All skirts &
dresses must be of fingertip length.
8. If your attire is seen as distasteful, you will be asked to change.
Enforcement
1. Individual sponsors, advisors, and chaperones are responsible for their clubs
adherence to the code of conduct
2. The Sergeant-at-Arms Committee shall be responsible for the enforcement of the
convention code of conduct. All attendees shall respect this authority vested
In the Sergeant-at-Arms Committee.
3. Infractions of this code will be reported to the district administrator and
appropriate action will be taken, including dismissal from the convention, if
necessary. In such cases, letters will be sent to the individuals parents, principal,
and sponsoring Kiwanis club.
4. Violations include, but are not limited to, destruction of property, possession
and/or consumption of alcoholic beverages and controlled substances, or any
illegal activity, such as theft, will result in the immediate dismissal from the event.
5. If any Key Clubber is dismissed from the event, the parent or guardian is required
to make arrangements to get the student home immediately, and will be
responsible for any costs associated. No exceptions.
6. This code is in effect from the time you depart for the event, until the time you
arrive home from the event.
2.
3.
4.
5.
6.
7.
8.
Since all rooms assigned for the purpose of conducting the caucus sessions
are also used for workshops, it would be helpful to clear the room as quickly
as possible. Make sure the room is cleaned.
9.
10.
11.
These rules are designed to allow for an orderly Caucus Session with full
opportunity to gain knowledge about each candidate
Governor
The governor is the chief executive officer of the district. The governor presides at all district
Board meetings and oversees the overall functioning of the district board and district committees,
The governor is charged with overseeing a program to help all clubs in the district have a successful year of
service. Duties of the governor include, but are not limited to:
1.
Attend & Preside at the Spring Board Meeting. (April10-12, 2015 Knoxville, TN)
2.
Attend the Governor/Administrator Training Conference (April 30 - May 3, 2015, Atlanta, GA)
3.
Attend the International Convention (June 23-28, 2015, Indianapolis, IN)
4.
Attend & Preside at the Summer Board Meeting. (July 10-12, 2015, Knoxville, TN)
rd
th
5.
Attend the International Leadership Training Conference. (TBD -3 or 4 Weekend in July,
Indianapolis, IN)
6.
Attend the Kiwanis District Convention. (August 14-16, 2015, Owensboro, KY)
7.
Oversee the planning, organization, and running of the Dollywood Fall Rally. (October 2015)
8.
Attend the Kiwanis Family Conference. (First Weekend in November, 2015, Black Mountain, NC)
9.
Attend the Winter Board Meeting. (November 13-15, 2015, Franklin, TN)
10.
Attend Kiwanis Mid-Year Conference (February, 2016)
11.
Preside at the District Convention, at the end of your year. (March 17-20, 2016, Franklin, TN)
12.
Produce and distribute newsletters to club presidents and to the board. (All year).
Secretary
The secretary takes and distributes minutes of all district board meetings. The secretary is
also responsible for district correspondence and reports, and produce a district directory.
Other duties of the secretary include but are not limited to:
1. Attend the Spring Board Meeting. (April10-12, 2015 Knoxville, TN)
2. If possible, attend the International Convention (June 23-28,2015, Indianapolis, IN)
3. Attend the Summer Board Meeting. (July 10-12, 2015, Knoxville, TN)
4. If possible, attend the Dollywood Fall Rally. (October 2015)
5. Attend the Winter Board Meeting. (November 13-15, 2015, Franklin, TN)
6. Attend the District Convention, at the end of your year. (March 17-20, 2016, Franklin, TN)
7. Produce and distribute newsletters to club secretaries and to the board. (All year).
Treasurer
The treasurer is responsible for the collection of district dues and for disbursing district
funds at the direction of the board of directors.
Other duties of the treasurer include, but are not limited to:
1. Attend the Spring Board Meeting. (April10-12, 2015 Knoxville, TN)
2. If possible, attend the International Convention (June 23-28, 2015, Indianapolis, IN)
3. Attend the Summer Board Meeting. (July 10-12, 2015, Knoxville, TN)
4. If possible attend the Dollywood Fall Rally. (October 2015)
5. Attend the Winter Board Meeting. (November 13-15, 2015, Franklin, TN)
6. Attend the District Convention, at the end of your year. (March 17-20, 2016, Franklin, TN)
7. Produce and distribute newsletters to club treasurers and to the board. (All year)
8. Maintain accurate records of board members expense accounts and distribute
expense checks in a timely manner.
Review and follow all the rules for District Campaigning (in the convention packet)
Prepare a short speech (1-2 minutes) for caucuses on Friday and Saturday,
and a speech for the house of delegates Sunday morning (3 min. limit for treasurer and secretary, 5
min. limit for governor). You must be registered for & present at the convention.
Be prepared to answer questions about Key Club. (Your experiences in Key Club,
Key Club knowledge [sample questions in packet], what you would do as an officer.)
Feel free to contact Governor, Maddie Potter or any district adult if you would like more information.
The retail value for all materials used in a campaign must not exceed $75. An itemized list of
expenses, including receipts, must be submitted to the elections committee chairperson. The
district board reserves the right to request samples of each type of campaign material. Flyers,
posters, buttons, etc. must all be in the $75 spending limit. If there is a question concerning
the value of campaign materials, the district board may have the materials examined by an
outside appraiser.
B.
Only candidates individual pictures may appear on posters, flyers, or any campaign materials.
C.
Candidates having access to confidential information which will be unveiled at the district
convention shall not include this information in their campaign materials.
D.
Candidate posters are to be displayed only in approved areas for that purpose. No materials
may be affixed to any hotel walls. Masking tape is recommended to post campaign materials
in the designated areas. Candidates may be disqualified for misuse of campaign material.
No campaign material may be displayed prior to 6 pm on Friday of the convention.
E.
The size of posters shall not exceed 17 inches by 22 inches (approximately one-half the size
of a standard poster board. The number of posters shall be limited to 5 per candidate. This
number includes all posters and flyers if they are affixed to walls, furniture, doors, etc. All
posters must be certified and approved by the District Board.
F.
If any hospitality suite or other similar function held in the name of any candidate is publicized
on the posters or flyers of any candidate, or if a function promotes the candidacy of any
candidate with members other than those from the candidates home club, all expenses must
be included in the $75 campaign spending limit. In addition, no campaign material may be
displayed in any hospitality suite.
G.
Any gifts given to promote the campaign of any candidate must be included in the $75
spending limit and a notarized document stating the giver and the value of the gifts must
accompany the other receipts.
H.
No meal function may be held to promote the candidacy of any member with members from
other clubs other than the candidates home club unless all expenses are included in the $75
spending limit.
I.
J.
K.
Each candidate must have approval of a school official and parent(s) in order to run for office.
L.
Any candidate guilty of forgery, fabrication, lying, or anything less than total honesty
concerning his or her campaign and the amount of money spent will have the illegal campaign
material confiscated by the Key Club district board. A candidate who has not totally complied
with the above rules and other board policies will risk disqualification.
M.
34.
35.
36.
37.
38.
39.
40.
41-50.
Key Club:
________________________________________________________
Address:
________________________________________________________
(Street)
________________________________________________________
(City)
(State)
(Zip Code)
________
________
________
I certify that the above information is correct to the best of our knowledge
Signatures
____________________________________
(Advisor)
____________________________________
(Key Club President)
Deadline:
(City)
(State)
_______________________________________
NOMINATION FORM:
OUTSTANDING KEY CLUBBER
K-T District Key Club
Name of Nominee:__________________________________________________
Address:
__________________________________________________
(street address)
__________________________________________________
(city)
(state)
(zip code)
_______________________________
Position: ____________________________________________________
NOMINATION FORM:
Name of Nominee:__________________________________________________
Address:
__________________________________________________
(street address)
__________________________________________________
(city)
(state)
(zip code)
_______________________________
Position: ____________________________________________________
NOMINATION FORM:
OUTSTANDING KIWANIS ADVISOR AWARD
K-T District Key Club
Name of Nominee:__________________________________________________
Address:
__________________________________________________
(street address)
__________________________________________________
(city)
(state)
(zip code)
_______________________________
Position: ____________________________________________________
NOMINATION FORM:
OUTSTANDING FACULTY ADVISOR
K-T District Key Club
Name of Nominee:__________________________________________________
School Address:
__________________________________________________
(street address)
__________________________________________________
(city)
(state)
(zip code)
_______________________________
Position: ____________________________________________________
NOMINATION FORM:
OUTSTANDING KEY CLUB SECRETARY
K-T District Key Club
Name of Nominee:__________________________________________________
Address:
__________________________________________________
(street address)
__________________________________________________
(city)
(state)
(zip code)
___Sophomore
___Junior
___Senior
_______________________________
Position: ____________________________________________________
NOMINATION FORM:
RONDALL D. HART
OUTSTANDING KEY CLUB PRESIDENT
K-T District Key Club
Name of Nominee:__________________________________________________
Address:
__________________________________________________
(street address)
__________________________________________________
(city)
(state)
(zip code)
___Sophomore
___Junior
___Senior
_______________________________
Position: ____________________________________________________
Name of Club____________________________________________________________
Name of Faculty Advisor___________________________________________________
Date
Amount
Ronald McDonald House
.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________
________________________________________________________________________
Signature of Club President:_______________________________________________
Signature of Club Treasurer:_______________________________________________
This can be done with a fax or email confirmation attached to this sheet.
acacia-camille-tribell@hotmail.com.
ORATORICAL CONTEST
This contest will be held at the District Convention at a designated time and
Place (as stated in the convention program) where complete quiet will be
Maintained at all times.
2.
There will be a time limit of one and one half hours in which time the entrant
Will develop and write his/her own essay of:
A.
From 250 to 350 words (to include all articles)
B.
On a topic not know to the contestants until they are in the contest
room, ready to begin.
3.
Any Key Clubber in good standing with Key Club International, the K-T
District, and his/her local club is eligible to enter. The entrant must also
Be registered for the district convention.
4.
Grammatical accuracy
Development of topic
Originality and clarity of thought
5.
6.
The decisions of the judges are final and no changes, alterations, or regradings
Will take place after the results have been certified by the judges, the
chairman of the judges, and the board counselor of this contest.
A Key Club may enter more than one act at the District Convention, but each
Key Club may have no more than one act entered in the International Talent
Contest.
2.
A clubs talent contest entry may take any form as long as it is entertaining
And in good taste. To help in classifying entries, the following categories for
acts have been decided upon.
Group I
Group II
Group III
Group IV
Group V
Group VI
Group VII
Group VII
Vocal Solos
Group Singing duets, quartets, choruses
Piano Solos classical and popular
Instrumental solos or group
Dancers solos or group
Skits or Variety Acts
Readings or recitations
Miscellaneous magicians, tumblers, etc.
3.
All participants in an act must be official members in good standing with Key
Club International, the K-T District, and their local club. In the case of a
group act, all members must be from the same club. All participants must also
Be registered for the convention.
4.
All acts entered in the District Talent Contest will be required to demonstrate
Their ability at a trial program (time and place to be announced in the
convention program). At this time, acts will be selected to appear in the
Talent Contest Finals.
5.
Selection of acts at the trial program, in so far as they are consistent with high
quality performance, will be final.
6.
Suitable awards will be presented to the three most outstanding acts (as
Determined by the judges) in the Talent Contest.
7.
The time limit on each performance must not exceed sic (6) minutes. Anyone
Exceeding this time limit will be disqualified.
8.
Any materials (props, instruments, costumes, etc.) that are needed for each
performance must be supplied by the contestants in that performance.
9.
The decisions of the judges are final and no changes, alterations, or regradings
Will take place after the results have been certified by the judges, the
chairman of the judges, and the board counselor to the contest.
Each Key Club may enter one of the two following contests:
A. TRADITIONAL SCRAPBOOK CONTEST
1. Each Key Club may enter a scrapbook containing pictures, souvenirs, examples, newspaper
clippings, etc. of its activities throughout the present district convention year (district convention to
district convention).
Each scrapbook must be subdivided into the following categories:
Service to School
Service to Community
Fundraising Projects
Assistance to Kiwanis Projects
Involvement with Major Emphasis
Miscellaneous
Each category must be tabbed accordingly.
The pages must also be numbered with a table of contents included at the beginning.
Judges will deduct five points for missing tabs and five points for a missing table of contents.
Only the first and second place winners in each division will be eligible to compete
in the international contest.
2.
Each entry is required to be submitted in a scrapbook binder no larger than 14 inches wide and 14
inches high. The cover may be decorated.
3.
4.
A sheet of paper must be affixed to the inside front cover of the scrapbook containing
the following: Key Club Name, City, State, District, and an Itemized Statement of the
total expenditures and donations. If this sheet of paper is not affixed to the inside front
cover of the scrapbook, the judges will deduct ten points. This statement must be
signed by the Key Club president and faculty advisor, stating the scrapbooks retail cost
value. (including photographic materials) does not exceed $300. Work done by Key Club members
such as hand lettering, artwork, etc. need not be included as cost items. Failure to comply with this rule
will result in disqualification.
5.
Entries may be turned in at the Registration Desk no later than 10:00 PM, Friday at the Convention.
6.
Suitable prizes will be awarded to scrapbooks judged best on the basis of format and general content.
Winning scrapbooks must not be changed or altered before judging in the international contest.
7.
The Scrapbook may contain materials from the end of last years district convention to the present.
8.
9.
The decisions of the judges are final, and no changes, alterations, or regradings will take place
after the results have been certified by the judges.
Each entry should adequately portray the following categories: Service to School, Service to
Community, Fundraising Projects, Kiwanis Family Functioning, Involvement with Major Emphasis
Program, and Miscellaneous.
3.
4.
5.
Entries may be turned in at the Registration Desk no later than 10:00 PM, Friday at the Convention.
6.
Suitable prizes will be awarded to entries judged best on the basis of creativity and general content.
Winning entries must not be changed or altered before judging in the international contest.
7.
The Scrapbook may contain materials from the end of last years district convention to the present
8.
No audio visual equipment or computer equipment will be allowed as part of the entry. The entry
must be sturdy to allow handling by the judges as necessary.
9. The decisions of the judges are final, and no changes, alterations, or regradings will take place
after the results have been certified by the judges.
The video must be produced by club members only at a cost not to exceed
$300.
2.
3.
4.
5.
6,
7.
8.
All entries will become the property of the K-T District and Key Club
International, and will not be returned to clubs. Key Club International and
the Kentucky- Tennessee Key Club District reserve the right to reproduce
and broadcast any contest entries
9.
All entries shall be in good taste and appropriate to the standards set
by the Objects of Key Club International.
10.
APPLICATION
ANDY HUTSON SCHOLARSHIP
Each year a $500 scholarship is made available to a Key Clubber by the Northside
Kiwanis Club in memory of former K-T Kiwanis Governor, Andy Hutson.
Please complete the following:
NAME_______________________________________________________
ADDRESS____________________________________________________
____________________________________________________
HIGH SCHOOL _______________________________________________
GRADE POINT ON A 4 POINT SCALE___________________________
ACT SCORES (or SAT scores) if not on your attached transcript.
English_________________
Science Reasoning_______________
Math___________________
Composite______________________
Reading_________________
KEY CLUB AND SCHOOL SERVICE (offices held, Key Club activities,
Honors, etc.) You may use extra paper
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
PLEASE WRITE (not more than 1 page) ON THE BACK OF THIS APPLICATION
WHY YOU DESERVE AND NEED THIS SCHOLORSHIP.
Please include your high school transcript and a letter of recommendation from your
High school principal, counselor, or a teacher
DEADLINE: Entries must be submitted by 10 pm, Friday at the Convention.
Middle
Last
_____________________________________________________________________________________
City
State
Zip Code
____ I have applied , been accepted, and will be attending the following school:
(The scholarship check will be mailed directly to the schools Financial Aid or Scholarship
Office. Please secure the address of this office).
University Name: _______________________________________________________________________
To which office should the check be mailed: __________________________________________________
Address: ______________________________________________________________________________
Campus Address
________________________________________________________________________________________________
City
State
Zip Code
_____________________________________________________________________________
City
State
Zip Code
SIGNATURES
Applicant __________________________________________Printed Name ________________________
Key Club Faculty Advisor__________________________ Printed Name _____________________
Applicants Parent __________________________________ Printed Name ________________________
Key Club Offices and Leadership Events: (elected or appointed positions on the club, district, or
International level. Also list any district/International conventions, training conferences, or leadership events
attended)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Campus Organizations and Activities: ______________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Religious and Community Activities: _______________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Honors, Awards, and Special Recognitions: _________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Attach two recommendations letters that describe your leadership ability: One from a Kiwanis Club member
or your Key Club Faculty Advisor, and one from a community or religious leader. The reference letters must
be no more than two pages in length, and the must be original letters that are dated and signed by your
references.
Attach a certified copy of your official high school transcript with an explanation of the grading process
utilized at the school
Deadline
Scholarship Application Forms must be turned in at the convention registration
desk by 10 pm Friday at the district convention.
For applicants not attending the convention:
The application may be mailed to Steve Phillips, P.O. Box 188, Flintstone, GA
th
30725. If the application is mailed, it must be received by March 13 , 2015.