FIVE As AWARD ANNUAL ACTIVITIES AND ACHIEVEMENTS AWARD GENERAL INSTRUCTIONS This report must be received by 5As Chair by June 1, 2019 It is suggested you review this entire report before filling in any of the forms or answering any of the questions. The report forms are broken down into sections as outlined in the Scoring Recap section on the Award cover page. To qualify for Strengthening of Exchange (Section C.), your Club must have participated in or completed seven (7) of the eleven (11) checked items. This instruction will be repeated at the beginning of that section to denote the importance of it. Your club must qualify in section C. to qualify for the 5As. Be sure the Club President and the Club Secretary/Preparer sign the report in the spaces provided on the Award cover page. The 5As Report covers the period from June 1 through May 31, unless otherwise specified in items as indicated. The report actually covers parts of two administrative years. Be careful not to overlook events prior to the current administrative year that qualify. The 5As Committee reserves the right to verify or to refigure the score of a submitted report if answers appear to be duplicates of answers in other parts of the report, or are incomplete with respect to the information requested, or do not follow the general instructions. Programs and Activities (Section A.) is divided into four parts: Community Service, Americanism, Youth and Child Abuse Prevention. No credit will be allowed for a Program or Activity that is not an official club project. These projects should be identified to the community as an Exchange Club Program or Activity. Explanations for Programs and Activities (Section A.) can be found in the booklets published by National, appropriate to each category. They can also be found in the National Exchange Club Awards Handbook and on the National web site - www.nationalexchangeclub.org The report forms for Section A. will follow the Program and Activities Application format found in the National Exchange Club Awards Book, (online at national website). Items entered on these forms should be detailed and documented, indicating the general nature of the activities and date (s) they took place. Example: Fifty smoke alarms were installed in homes of elderly during the period from September November, 2018. Eight Exchangites were involved. A newspaper clipping is included. 1
There are no minimum dollar amounts for Fund Raising (Section B.). Please list all of your fund raisers, large and small. Explanations for the Distinguished Service Award and the Contributing Service Award (questions 16 and 17 Strengthening of Exchange Section C.), can be found in the Lincolnland District Directory. Each Club Officer and each Division Director receives a copy of the directory. Questions regarding the completion of this report should be referred to the Chairpersons of the 5As Committee or your Division Director. Reports submitted to the 5As Committee will be returned to each Club through the District Division Directors, or by the Chairpersons, following the annual District Convention. A well-prepared report is a written history of your club. NOTE: Including supporting documentation is encouraged (pictures, newspaper articles, event programs, etc.). NOTE: An overall attendance percentage form is on page 15. You may use this form or the separate Membership Attendance Percentage Excel sheet. Save this Excel sheet to your computer and fill it in as you meet throughout the year. The Excel sheet is much easier since it calculates percentage as you make each entry. This report must be received by 5As Chair on by June 1, 2019 Janet Jacobs jacobs.janet@comcast.net 8S237 Aintree Drive, Naperville, IL 60540 Phone 630-710-9433 2
a) Book of Golden Deeds A. PROGRAMS & ACTIVITIES I. COMMUNITY SERVICE 1. NATIONAL PROGRAMS Date: Recipient: b) Crime Prevention Date: Project Title and Description: Date: Project Title and Description: c) Fire Prevention Date: Project Title and Description: Date: Project Title and Description: d) Service to Seniors Date: Project Title and Description: e) National Day of Service Date: Description: 3
2. OTHER COMMUNITY SERVICE PROGRAMS & ACTIVITIES Many Clubs have Community Service programs and activities that are not included in the National listing. List those programs in the space below, and other programs that don t fit here, on a separate sheet marked APPENDIX A: COMMUNITY SERVICE. (Use the appendix sheet, also, if you need more space for program details on this page or the previous Community Service page.) (To be completed by 5As Committee) Yes No Community Service Qualified / 4
A. PROGRAMS & ACTIVITIES II. AMERICANISM 1. NATIONAL PROGRAMS a) 1. Freedom Shrine Dedication Date: Location: Date: Location: a) 2. Freedom Shrine Rededication Date: Location: Date: Location: a) 3. Voices of Freedom Plaque (s) Date: Location: Date: Location: b) GIVEAKIDAFLAGTOWAVE Date: Location: Date: Location: Date: Location: c) One Nation under God Date: Location: Program Description: d) Proudly We Hail (minimum of 6 required) Date: Recipient: Date: Recipient: Date: Recipient: Date: Recipient: 5
Date: Recipient: Date: Recipient: e) Get out The Vote Date: Location: Description: _ f) Healing Field of Honor Date: Location: Description: g) Military Appreciation Date: Recipient: Description: 6
2. OTHER AMERICANISM PROGRAMS & ACTIVITIES Many Clubs have Americanism programs and activities that are not included in the National listing. List those programs in the space below, and other programs that don t fit here, on a separate sheet marked APPENDIX B: AMERICANISM. (Use the appendix sheet, also, if you need more space for program details on this page or the previous Americanism pages.) Date: Description: _ Date: Description: _ Date: Description: _ Date: Description: _ Date: Description: _ Date: Description: (To be completed by 5As Committee) Yes No Americanism Qualified / 7
A. PROGRAMS & ACTIVITIES III. YOUTH 1. NATIONAL PROGRAMS a) Youth of the Month (minimum of 6 required) a) 1. Youth of the Year a) 2. District Nomination for Youth of the Year b) Young Citizenship (minimum of 6 required) c) 1. A.C.E. Award (s) 8
c) 2. Entry for District A.C.E. Award Recipient of the Year d) 1. Sponsored an Excel Club Name of Club: d) 2. Built an Excel Club Name of Club: (Note: Do not take credit for both Excel Club items!) 9
2. OTHER YOUTH PROGRAMS & ACTIVITIES Many Clubs have Youth programs and activities that are not included in the National listing. List those programs in the space below, and other programs that don t fit here, on a separate sheet marked APPENDIX C: SERVICE TO YOUTH. (Use the appendix sheet, also, if you need more space for program details on this page or the previous Youth pages.) (To be completed by 5As committee) Yes No Youth Qualified / 10
A. PROGRAMS & ACTIVITIES IV. CHILD ABUSE PREVENTION 1. NATIONAL PROGRAMS a) National Exchange Child Abuse Prevention Center-related activities (not donations) Date: Description: Date: Description: Note: There are two National Exchange Club Child Abuse Prevention Centers in Illinois the Guardian Angel Home in Joliet and Project HELP DuPage in Naperville. There is a list of all the other CAP centers on the National Exchange Club website www.preventchildabuse.com/content/find-cap-center b) National Child Abuse Prevention activities which are not CAP Center-related (Believe in the Blue, for example) Date: Description: Date: Description: c) Club Donations - Put a check in front of each of the options below to which your Club donates, then fill in the rest of the required information. c) 1. Donated to: Exchange Strong Campaign Amount donated: c) 2. Donated to: National Exchange Club CAP Center(s) (see note above) 11
Name of center: Amount donated: Name of center: Amount donated c) 3. Donated to: Local CAP Organization(s) or Program(s) Name of organization: Amount donated: Name of organization: Amount donated: Name of organization: Amount donated: Name of organization: Amount donated: Name of organization: Amount donated: c) 4. Donated to: National Exchange Club Foundation Amount donated: c) 5. Donated to: Lincolnland District Exchange Club Foundation or other foundations formed by local clubs within the Lincolnland District* Name of foundation: Amount donated: Name of foundation: Amount donated: * Some of the Exchange clubs in this District have set up their own Child Abuse Prevention foundations. 12
2. OTHER CAP PROGRAMS & ACTIVITIES Many clubs have Child Abuse Prevention programs and activities that are not included in the National listing. List those programs in the space below, and other programs that don t fit here, on a separate sheet marked APPENDIX D: CHILD ABUSE PREVENTION. (Use the appendix sheet, also, if you need more space for program details on this page or the previous Child Abuse Prevention pages.) Briefly describe any specific CAP programs and activities held during Child Abuse Prevention Month (April) which are not National programs of service. Date: Description: Date: Description: Briefly describe any CAP educational seminars your club sponsored or co-sponsored. Date: Location: Topic/Agenda: Date: Location: Topic/Agenda: Briefly describe any additional CAP efforts not listed above: Date: Description: Date: Description: 13 (To be completed by 5As committee) Yes No CAP Qualified /
B. FUNDRAISING List all fundraising projects held by your club, including the event, the date, and the net cash proceeds after expenses. Project or Event Date Net Proceeds If additional space is necessary, attach a sheet marked APPENDIX E: FUNDRAISING. (To be completed by 5As committee) Yes No Fund Raising Qualified / 14
WEEKLY ATTENDANCE & MEMBERSHIP DATA Used to determine attendance percentage for the period June 1 through May 31 (CLUB MEMBERS ONLY - DO NOT COUNT GUESTS) Membership Total Club Membership Total Club Date Attendance Membership Date Attendance Membership 1. 27. 2. 28. 3. 29. 4. 30. 5. 31. 6. 32. 7. 33. 8. 34. 9. 35. 10. 36. 11. 37. 12. 38. 13. 39. 14. 40. 15. 41. 16. 42. 17. 43. 18. 44. 19. 45. 20. 46. 21. 47. 22. 48. 23. 49. 24. 50. 25. 51. 26. 52. To determine overall attendance percentage figure, divide the total of the Membership Attendance column by the total of the Total Club Membership column. Multiply the result by 100. Overall Attendance Percentage:. % 15