Lt. Governor Candidate Form

This form is to be completed by candidates that meet the below requirements for Lt. Governor.

Requirements

• As per bylaws, each Lieutenant Governor and Lieutenant Governor-elect shall be a member of a club in the division from which they are elected;
• shall have served a full term as a club president, vice-president, secretary, or treasurer; and shall be active in the affairs of their club and their division.
• However, if there is no member from a club in a particular division qualified and willing to serve as lieutenant governor, a member of a club in another division may serve when approved by the board.

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1Candidate Information

2Candidate Kiwanis Experience

3Skills, Candidate Statement and Photo

Lt. Governor Candidate Information

Candidate's Name(Required)

First Last

Nickname (if any)

Address(Required)

Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code

Your Email Address(Required)

Valid email address used for Kiwanis correspondence.

Enter Email Confirm Email

Home Phone(Required)

Cell Phone(Required)

Candidate's Kiwanis Experience

Complete indicating required past positions held.

Member of the Kiwanis Club of:(Required)

Indicate the club in which you are a member.

Are you a member in good standing?(Required)

All financial obligations have been met to be a member in good standing.

Yes

No

Are you a returning Lt. Govermor?

Yes

No

Lieutenant Governor Division(Required)

The division that you are applying for Lt. Governor.

Lieutenant Governor Division

This is the division where you were Lt. Governor.

Term(s)

Indicate the term(s) in years, that you were Lt. Governor (eg 2021-2022, 2022-2024)

Lt Governor Experience

As per bylaws, each Lieutenant Governor and Lieutenant Governor-elect shall be a member of a club in the division from which they are elected; shall have served a full term as a club president, vice-president, secretary, or treasurer; and shall be active in the affairs of their club and their division. However, if there is no member from a club in a particular division qualified and willing to serve as lieutenant governor, a member of a club in another division may serve.

Club Officer Position Held

Fiscal Year(s) Served

 

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Your Previous Club, District or International Positions Held(Required)

Please chronologically list your previous positions held starting with the most recent, the dates you served and District (if not Pennsylvania). For International Position, put KI under District.

Position

Dates (eg 2022-2023)

Level (Club/District/ KI)

District Served

 

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Kiwanis Awards or Recognitions Received

This may include Distinguished Kiwanian, Hixon Fellow, Zeller Fellow, Lifetime memberships, Will Blechman Fellow etc. Please indicate Award/Recognition, Year Received and if it was a District or Kiwanis International Award.

Award Name

Year Received

Disitrict or KI Award

 

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More About You

Indicate Skills you Possess to be a Lt. Governor(Required)

Indicate any skills that you feel that will be a value added to the role of Lt. Governor.

Candidate Statement:(Required)

Indicate how you intend to fulfill the role.

Upload Your Photo(Required)

Upload your Photo can be in .jpg, .gif, .bmp or .png format

Accepted file types: jpg, gif, png, bmp, pdf, Max. file size: 25 MB.

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Terms and Conditions(Required)

By filling out the above information, you are hereby granting your permission for the PA District to publish on the website and/or print for distribution.

I agree to the terms and conditions.

Signature(Required)