Texas-Oklahoma District of Kiwanis International

Layperson of the Year

Nomination Form Instructions

The attached Nomination Form may be reproduced as needed. Please try to make good, straight, clean copies on good quality paper if possible.

Every Club in Kiwanis has one or more members deserving of special recognition for not only outstanding Kiwanis service but also activities in their respective churches, synagogues, or temples, and in the community. These folks are ideal candidates for “Layperson of the Year.” Remember, however, that, as the title suggests, nominees should not be in the clergy.

This year, we encourage each Club to either have a Prayer Breakfast or participate in its Division-wide Prayer Breakfast. Typically these occur in May of each year and are the perfect occasions to recognize and honor each Club’s and/or Division’s “Layperson of the Year.”

Each Club may, of course, select its “Layperson of the Year” at any time. Appropriate local recognition should be given to the Club winner during a special ceremony at the Club’s Prayer Breakfast, at a Club meeting, at some other Club function, or at the Division Prayer Breakfast.

The completed Nomination Form of each individual Club’s winner should be sent to its Lt. Governor by May 1, 2010 (or as soon as necessary to allow a selection to be made of a Division “Layperson of the Year” prior to that Division’s Breakfast). Division-wide recognition should be given to the Division winner during a special ceremony as deemed appropriate.

Each Lt. Governor is to submit, to the District Chair by May 31, 2010, a single completed Nomination Form, with all supporting paperwork, for its Division winner. Please assure that Nomination Forms submitted to the District Chair include all information requested on the form, including signatures as indicated, the recommendation letter(s), and the photograph (although the photograph, alone, can be reserved, if not available, or at the option of nominee, until following the selection of the District winner).

Lt. Governors should forward their Division winner’s form to:

Richard O. Witte, Human & Spiritual Values Chair

802 South 8^th Street

Chickasha, OK 73018-4428

Feel free to call with questions: Phone (405) 222-2313 (Home), (405) 224-1000 (Office), or rojawitte@aol.com (Email).

NOMINATION FORM

KIWANIS INTERNATIONAL TEXAS OKLAHOMA DISTRICT

LAYPERSON OF THE YEAR

Nominee: _______________________ Date: _

Last Name First Name Middle/Initial

Home Address: ________________________________________________________________

Number & Street Apt. /Suite No. City State Zip Code

Telephone Number: (____)_______________(_____) ______________(_____)_____________

Business Home Fax

Family Information [names/relationships]: __________________________________________

_____________________________________________________________________________________

Business/Profession/ Name of Business

Occupation: ____________________________ Employer: _______________________________

Type of Business: ______________________________________________________________________________________

Kiwanis Involvement [membership history, activities, positions held, honors, etc]:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

(Attach additional sheet if necessary)

Church/Temple/

Synagogue: _______________________________ Phone No:(_____)_______________________

Address:

______________________________________________________________________________________

Number & Street City State Zip Code

Minister/Pastor/Rabbi:_____________________ Phone No:(_____)_____________________

Nominee’s activities in local congregation: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Other activities representing his/her faith: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Other Humanitarian and/or Spiritual activities:

(Attach additional sheet for any of the above if necessary)

Nomination Form LAYPERSON OF THE YEAR Page 2

List persons (Kiwanis and/or others) from whom letters of recommendation are attached:

[Not more than five (5)]

1. ________________________________

2. ________________________________

3. ________________________________

4. ________________________________

5. ________________________________

Nominating Club Information:

Club: _________ President: _Phone No.:______________

Address: ______________________________________________________________________

Number & Street City State Zip Code

Chairperson, Human & Spiritual Values:Phone No: _

Affix here a recent 2.5” X 3.5” black & white photograph: [optional with initial submission]

Place Photo Here

Nominee’s Commitment: By signing below, I understand that the photograph requested above, if not initially attached, and letters of recommendation from my Minister, Pastor, or Rabbi are required for final winner selection.

Signature of Nominee: ________________________________________

Nomination Deadline is May 1, 2010. Send completed Nomination Form to your Division Lt. Governor for selection of a Division winner. Then, together with photograph and required recommendation letter, send to the District Chairperson for Human and Spiritual Values (Richard O. Witte, 802 South 8^th Street, Chickasha, OK 73018-4428) by May 31, 2010 for selection as Layperson of the Year.