2017-2018 Distinguished District Governor

DISTINGUISHED DISTRICT GOVERNOR
Award Application: CKIx 2018

Deadline: Received by May 4th, 2018 at 12PM EDT
Circle K International at: Colorado State University

Name of Applicant: Kaori Keyser
Email of Applicant: kmkeyser@rams.colostate.edu
District: Rocky Mountain District
The Frank B. Fulton Distinguished District Governor Award was designed to recognize District
Governors who provide guidance to their fellow District Board Officers, opportunities for
members throughout their district, and inspiration for any member who seeks to change the
world.
GENERAL GUIDELINES
* An evaluation will be made on the basis of the criteria set forth. This is not a contest between District
Officers but rather recognition of an individual's performance.
* Only persons elected or officially appointed to the position of District Governor and who have served a
minimum of six (6) months in office may submit applications for consideration.
* In order to be eligible for this award, the nominee must have complied with all aspects of the Circle K
International Bylaws, Policy Code, and respective District Bylaws, Policy Codes, and Operating Procedures.
* Out of 2,250 possible points, the nominee must accumulate a total of at least 2,025 points (90%).
* Application and supplements submitted cannot exceed one hundred (100) pages total.
* Acceptable forms of communication include emails, instant messages (including Facebook, Slack, etc.),
newsletters, phone conversations or written correspondence.
* If you would like special consideration for any of the criteria, please include a letter of
explanation signed by your District Administrator and place it at the end of your submission.
* All applications must be submitted online by the deadline stated at the top of this application.
No late submissions will be considered.
QUALIFYING CRITERIA
* Did the District Governor serve a minimum of six (6) months in office?
* Did the District Governor pay District Dues by November 30th, 2017?
* Did the District Governor meet or surpass their home club's minimum membership
requirements?
Circle K International_x000D_Distinguished District Governor Award

_x000D_ Cover Page_x000D_Page 1 of 35
DISTINGUISHED DISTRICT GOVERNOR AWARD CHECKLIST
Use the drop-down list in each of the yellow boxes to indicate either "Complete" or
"Incomplete."
Cover Page
There are 13 sections to this award:
I. Communication (210 Points)
II. Board Meeting Agendas (50 Points)
III. Required Attendance (90 Points)
IV. Active Clubs (50 Points)
V. Membership (100 Points)
VI. Kiwanis Family Relations (100 Points)
VII. Club President Training (100 Points)
VIII. Visitations (200 Points)
IX. International Relations (200 Points)
X. Service (200 Points)
XI. Home Club Improvement (100 Points)
XII. Setting and Achieving Goals (200 Points)
XIII. Above and Beyond (650 Points)

ERNOR
CKIx 2018
12PM EDT
d to recognize District
s, opportunities for
o seeks to change the
test between District
nd who have served a
spects of the Circle K

d Operating Procedures.
025 points (90%).
total.
Facebook, Slack, etc.),
lude a letter of
of your submission.
top of this application.
-
-

KLIST
er "Complete" or
-
-
-
-
-
-
-
-
-
-
-
-
-

Please readjust cell width/height or margins accordingly if formatting issues are
encountered.
To add more rows, right-click the numbers on the left and click "Insert."
You may find this useful if you need to add more space for your response(s).
List the total number of communications made to clubs during your term as District
Governor. Please see the Cover Page for acceptable forms of communication. (10
A.
Points/communication, Max 50)
NOTE: Communications are independent conversations, not individual messages.
Number of communications with clubs:
Please provide two (2) examples of club correspondence for each of the topics below. At
the top of each example, label it as "Club Communication" and place it in your
B.
Submissions folder. Write the date of each correspondence in the table below (50
Points).
Topic Date(s) Included?

Interntional Preferred Charities/Service Partners -
Tomorrow Fund -
Kiwanis Family -
District Convention -
International Convention (CKIx) -
List the total number of communications with District Board members during your term
as District Governor. Please see the Cover Page for acceptable forms of communication.
C.
NOTE: Communications are independent conversations, not individual messages (50
Points).
Number of communications with District Board members:

Communication_x000D_Page 5 of 35
Please provide two (2) examples of District Board correspondence for each of the topics
D. below. For each example, label it as "Board Communication" and place it in your
Submissions folder (60 Points).
Topic Included?
Tomorrow Fund -
Kiwanis Family -
Club Building -
District Convention -
International Convention (CKIx) -
CKI Alumni Association -
Subsection Points Awarded

Question A 0
Question B 0
Question C 0
Question D 0
Subtotal 0
SECTION I TOTAL 0/210

sues are
rt."
nse(s).
s District
n. (10
sages.
pics below. At
our
ow (50
ng your term
mmunication.
sages (50

of the topics
your

encountered.
After answering the question below, please compile and provide examples of District
A. Board meeting agendas as proof. For each example, mark it as "Board Meeting
Agendas" and include them in your Submissions folder(50 Points).
Number of District Board meetings you held with an official agenda distributed at least
one week prior to the meeting:
All pieces of evidence MUST include timestamps to ensure validity. Lack of timestamps will
result in 0 Points for this section. Modified timestamps will result in disqualification of this
application.

Question A 0
Subtotal 0
SECTION II TOTAL 0/50
Circle K International_x000D_Distinguished District Governor

Board
Award
Meeting Agendas_x000D_Page 9 of 35
tting issues are
amples of District
rd Meeting
ck of timestamps will
squalification of this

BoardAward
Meeting Agendas_x000D_Page 10 of 35
encountered.
Complete the prompt in 500 words or fewer.
A. Indicate your attendance at the following events during your term.

1. Did you attend your district's 2017 District Convention?
2. Did you attend your district's 2018 District Convention?
3. Did you attend your district's Fall Conference?
4. Did you attend CKIx17 in San Antonio, Texas?
5. Did you attend 100% of your District Board meetings?
6. Did you attend the District Board Training Conference?
7. Did you attend the Governor's and Administrator's Training Conference (GATC)?
Were you elected or appointed following the dates of any of the above
events?
Only if you selected "Yes" to the above question: In the space below, list which event(s) you were
unable to attend, detail why you were interested in serving as District Governor, and explain how you
overcame the setbacks from not attending these events.
Enter response here or N/A.
Word Count: 5

Question A 0
Subtotal 0
SECTION III TOTAL 0/90

Required
Award Attendance_x000D_Page 11 of 35
SECTION III TOTAL 0/90

Required
ormatting issues are
er.
d click "Insert."
your response(s).
erm.
-
-
-
-
-
-
-
-
, list which event(s) you were

vernor, and explain how you
vents.

Required
encountered.
Excel will automatically calculate the percentages for you.
Please enter the appropriate values in the table below to calculate the number of active
A. clubs in your district throughout your term. For each club that your district has
chartered, you will earn 10 Points with a Max of 50 Points.
1. Number of Active Clubs at the end of the 2016-2017 service year:

Note: You can find this information on Kiwanis One under SLP Reports.
2. Number of Active Clubs as of March 31, 2018:
Clubs Increase: 0

Question A 0
Subtotal 0
SECTION IV TOTAL 0/50
Circle K International_x000D_Distinguished District Governor AwardActive Clubs_x000D_Page 14 of 35

ues are
ber of active
has
Circle K International_x000D_Distinguished District Governor AwardActive Clubs_x000D_Page 15 of 35

V. Membership (100 Points)
encountered.
Excel will automatically calculate the percentages for you.
Please enter the appropriate values in the table below to calculate the number of
A. active members recognized throughout the term. Your district must have grown by
at least 20% to receive the full 100 points.
1. District Membership Total at the end of the 2016-2017 service year:

91
Note: You can find this information on Kiwanis One under SLP Reports.
2. District Membership Total as of April 15, 2018:
Membership Growth %: 0.00%

Question A 0.00
Subtotal 0.00
SECTION V TOTAL 0/100
Circle K International_x000D_Distinguished District Governor AwardMembership_x000D_Page 16 of 35

encountered.
A. Indicate your attendance at the following events during your term (25 Points each).
1. Did you attend at least two (2) Kiwanis District Board Meetings?
2. Did you attend at least one (1) Key Club District Board Meeting?
3. Did you attend the Kiwanis District Convention or other Kiwanis Events?
4. Did you attend the Key Club District Convention or other Key Club District Events?

Question A 0
Subtotal 0
SECTION VI TOTAL 0/100

Kiwanis
Award
Family Relations_x000D_Page 17 of 35
erm (25 Points each).

-
-
-
-

Kiwanis
Award
Family Relations_x000D_Page 18 of 35
encountered.
A. In your training of club presidents, did you inform them of the following? (100 Points)
International Preferred Charities/Service Partners
Tomorrow Fund
Kiwanis Family
Role of the Club President
Emphasis on Club Building and Reactivation
Communication Responsibilities
Goal Setting
Dues Collection Education/Process
Service Hour Reporting
Involvement with the District

Question A 0
Subtotal 0
SECTION VII TOTAL 0/100

Club Award
President Training_x000D_Page 19 of 35
following? (100 Points)

-
-
-
-
-
-
-
-
-
-

Club Award
President Training_x000D_Page 20 of 35
VIII. Visitations (200 Points)
encountered.
A. If your District has Divisions, please complete this section ONLY (200 Points).
How many divisions are in the district you serve?
How many divisions did you visit at least once during your term?
If your District DOES NOT have divisions, please complete this section ONLY (200
B.
Points).
How many clubs are In the district you serve?
How many clubs did you visit at least once during your term?

Question A 0.00
Question B 0.00
Subtotal 0.00
SECTION VIII
0/200
TOTAL
Circle K International_x000D_Distinguished District Governor Award Visitations_x000D_Page 21 of 35

encountered.
A. The following questions regard your relationship with the International level of Circle K.
Did you offer your International Representative time at District Board meetings? (30
Points)
Did you communicate with your International Representative as agreed upon in your
Governor-International Representative agreement? (25 Points)
Did you invite your International Representative to all district-wide events and offer them
time to address attendees at these events? (25 Points)
Number of Monthly Reports submitted to Circle K International ON TIME: (60 Points)
Note: 0-60 Points will be awarded based on the quality of Monthly Reports submitted.

Question A 0
Subtotal 0
SECTION IX
0/200*
SUBTOTAL

International
Award Relations_x000D_Page 22 of 35
ting issues are
nal level of Circle K.

-
eports submitted.

International
Award Relations_x000D_Page 23 of 35
encountered.
How many hours of community service did you perform during your term as District
A. Governor through Circle K activities between April 1, 2017 and March 31, 2018? (2
Points per hour; Max of 150 Points).
Number of hours of service completed:
How many hours of community service WITH OTHER KIWANIS FAMILY MEMBERS did you
B. perform during your term as District Governor through Circle K activities between April
1, 2017 and March 31, 2018? (2 Points per hour; Max of 50 Points).
Number of hours of service completed with the Kiwanis Family:
Please compile verification of service hours completed via Monthly Reports, etc. mark
them as "Service" and include it with your submission.

Question A 0
Question B 0
Subtotal 0
SECTION X TOTAL 0/200
Circle K International_x000D_Distinguished District Governor Award Service_x000D_Page 24 of 35

ues are
s District
018? (2
BERS did you

etween April
Circle K International_x000D_Distinguished District Governor Award Service_x000D_Page 25 of 35

XI. Home Club Involvement (100 Points)
encountered.
As a District Board Officer, it is important to maintain the responsibilities with which you
A. are charged. It is also important to be a role model for your home club by remaining
active and involved with meetings and other activities.
Note: For this section, do not include meetings missed due to class, exams, sickness,
District Board meetings, or other club visitations.
1. Number of Home Club meetings:
2. Number of Home Club meetings attended
Meetings Attended %:

Question A 0.00
Subtotal 0.00
SECTION XI TOTAL 0/100

HomeAward
Club Involvement_x000D_Page 26 of 35
XI. Home Club Involvement (100 Points)
ues are
ith which you

emaining
sickness,

HomeAward
Club Involvement_x000D_Page 27 of 35
encountered.
A. This section will evaluate your goals throught your term as District Governor.
1. Did you submit a copy of your goal sheet to CKI for the current year within 45 days
of taking office?
2. Did you explain your goals in 300 words or less per goal?
Please provide a copy of the goal sheet you submitted to CKI and mark it as "Setting and
Achieving Goals." If you did not submit your goal sheet to CKI, please explain why not, what
your goals were, and how you achieved them. (Goals not submitted: 100/200 Points
possible.)
In 300 words or fewer per goal, describe how each goal was met. If a goal was not achieved,
explained what you learned as a result of not accomplishing this goal.
Enter response here or N/A.
Word Count: 5
The CKI judges will evaluate goals and goal explanations, awarding 0 to 100 points.

Question A 0
Subtotal 0
SECTION XII
0/100*
SUBTOTAL

Setting and
Award
Achieving Goals_x000D_Page 28 of 35
d click "Insert."
your response(s).
trict Governor.
-
d mark it as "Setting and
ase explain why not, what
mitted: 100/200 Points
f a goal was not achieved,

shing this goal.
rding 0 to 100 points.

Setting and
Award
Achieving Goals_x000D_Page 29 of 35
encountered.
A. This section requires an essay to be submitted (100 Points).
On a separate document, please write no more than 500 words answering the following question: Why
do you believe you are a Distinguished District Governor? Include this document with your
submission.
* CKI Judges will evaluate your essay holistically and award points from 0-100. Your response should be
honest and sincere as to why you deserve this award.
B. This section will assess your Above and Beyond performance (250 Points).
* Submit evidence of performance above and beyond the call of duty, including recommendations and
documentation of achievements not covered in Sections 1-12 of this application.
* You may submit as many pieces of evidence as you like, but the first five (5) pieces will be individually
judged and are worth 50 Points each.
* For each piece of evidence, please write no more than 100 words about as to why you have
included it in "Above and Beyond" and what significance it adds to your application.
* The last 100 Points are awarded at the discretion of the CKI Judges and do not require written
supplementation. Judges will review all pieces of evidence behind the "Above and Beyond" tab. Please
mark all materials as "Above and Beyond" and include them with your submission.
Pieces of Evidence for Consideration:
The CKI Judges will evaluate the Above and Beyond evidence, determining 100 Points.

Above and Beyond_x000D_Page 30 of 35
C. This section requires TWO essays to be submitted (200 Points)
In order to be eligible for this award, you must also include two (2) letters of recommendation from
your District Board of Officers. Optionally, your District Administrator may write one of the two letters.
These letters should be no more than 750 words each and highlight personal and professional
reasons as to why you deserve to be recognized as a Distinguished District Governor. Include them with
your submission.
* CKI Judges will evaluate each of these essays holistically and award points from 0-100. Responses
should be honest and sincere as to why you deserve this award.

Question A TBD
Question B 0
Question C TBD
Subtotal 0
SECTION XIII
0/250*
SUBTOTAL

nd click "Insert."
your response(s).
the following question: Why

his document with your
00. Your response should be
250 Points).
ding recommendations and

ation.
(5) pieces will be individually
ut as to why you have

plication.
o not require written

ve and Beyond" tab. Please
mission.
determining 100 Points.

of recommendation from
write one of the two letters.
rsonal and professional
ct Governor. Include them with
s from 0-100. Responses

Scoring Sheet
encountered.
DISTINGUISHED DISTRICT GOVERNOR AWARD APPLICATION

Meets Cover Page Basic Requirements
Section I Total - Communication
Section II Total - Board Meeting Agendas
Section III Total - Required Attendance
Section IV Total - Active Clubs
Section V Total - Membership
Section VI Total - Kiwanis Family Relations
Section VII Total - Club President Training
Section VIII Total - Visitations
Section IX Total - International Relations
Section X Total - Service
Section XI Total - Home Club Improvement
Section XII Total - Setting and Achieving Goals
Section XIII Total - Above and Beyond
SECTIONS SUBTOTAL
AWARD ADJUSTED SUBTOTAL
Signature: Print Name:
Position/Title: Date:
THIS CONCLUDES THE DISTINGUISHED DISTRICT

GOVERNOR AWARD APPLICATION.

Scoring Sheet_x000D_Page 34 of 35
Scoring Sheet
LICATION
No
0
0
0
0.00
0.00
0
0
0.00
0
0
0.00
0
0
0.00
0/2250
D DISTRICT
ION.

Scoring Sheet_x000D_Page 35 of 35

2017-2018 Distinguished District Governor

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DISTINGUISHED DISTRICT GOVERNOR

Award Application: CKIx 2018

Circle K International at: Colorado State University

Circle K International_x000D_Distinguished District Governor Award

Circle K International_x000D_Distinguished District Governor Award

test between District

nd who have served a

spects of the Circle K

top of this application.

Circle K International_x000D_Distinguished District Governor Award

Circle K International_x000D_Distinguished District Governor Award

Topic Date(s) Included?

Circle K International_x000D_Distinguished District Governor Award

Subsection Points Awarded

SECTION I TOTAL 0/210

Circle K International_x000D_Distinguished District Governor Award

Circle K International_x000D_Distinguished District Governor Award

Circle K International_x000D_Distinguished District Governor Award

Subsection Points Awarded

SECTION II TOTAL 0/50

Circle K International_x000D_Distinguished District Governor

Circle K International_x000D_Distinguished District Governor

A. Indicate your attendance at the following events during your term.

Enter response here or N/A.

Subsection Points Awarded

SECTION III TOTAL 0/90

Circle K International_x000D_Distinguished District Governor

Circle K International_x000D_Distinguished District Governor

, list which event(s) you were

Circle K International_x000D_Distinguished District Governor

1. Number of Active Clubs at the end of the 2016-2017 service year:

Subsection Points Awarded

SECTION IV TOTAL 0/50

Circle K International_x000D_Distinguished District Governor AwardActive Clubs_x000D_Page 14 of 35

Circle K International_x000D_Distinguished District Governor AwardActive Clubs_x000D_Page 15 of 35

1. District Membership Total at the end of the 2016-2017 service year:

Membership Growth %: 0.00%

Subsection Points Awarded

SECTION V TOTAL 0/100

Circle K International_x000D_Distinguished District Governor AwardMembership_x000D_Page 16 of 35

Subsection Points Awarded

SECTION VI TOTAL 0/100

Circle K International_x000D_Distinguished District Governor

erm (25 Points each).

Circle K International_x000D_Distinguished District Governor

Subsection Points Awarded

SECTION VII TOTAL 0/100

Circle K International_x000D_Distinguished District Governor

following? (100 Points)

Circle K International_x000D_Distinguished District Governor

Subsection Points Awarded

Circle K International_x000D_Distinguished District Governor Award Visitations_x000D_Page 21 of 35

Number of Monthly Reports submitted to Circle K International ON TIME: (60 Points)

Subsection Points Awarded

Circle K International_x000D_Distinguished District Governor

nal level of Circle K.

Circle K International_x000D_Distinguished District Governor

Number of hours of service completed:

Number of hours of service completed with the Kiwanis Family:

Subsection Points Awarded

SECTION X TOTAL 0/200

Circle K International_x000D_Distinguished District Governor Award Service_x000D_Page 24 of 35

BERS did you

Circle K International_x000D_Distinguished District Governor Award Service_x000D_Page 25 of 35