Kairos Outside Excellence Initiative

Kairos Outside: Excellence Initiative Report - Pre Program

Part 1
To be completed and submitted prior to the start of the Weekend

The information provided in this form will be used to complete the final EI Report that you give at the end of the Weekend.
To enhance the quality and effectiveness of our ministry for the benefit of Guests.

Note:
- The completed form must be submitted as soon as possible prior to the start of the Weekend.
- You will be provided with information to help complete this form by email from the Kairos Support Office as part of the Program Notification Form process.
- Use the tabs at the top of this form to navigate between pages.
- Please click here for instructions on how to use this online form if you need further information.
Step 1: Contact Information
Regional Committee and Weekend Number

RegionNumber #
Kairos Weekend Venue
Kairos Weekend Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
EI State Administrator Name

FirstLast
EI State Administrator Email
example@kairos.org.au
EI State Administrator Phone Number
Please enter a valid phone number.Format: 0000-000-000.
State Council
State Council Chair Name

First NameLast Name
State Council Chair Email
example@kairos.org.au
State Council Chair Phone Number
Please enter a valid phone number.Format: 0000-000-000.
Regional Committee
Regional Committee Chair Name

First NameLast Name
Regional Committee Chair Email
example@kairos.org.au
Regional Committee Chair Phone
Please enter a valid phone number.Format: 0000-000-000.
Excellence Initiative Representative

The person nominated by the Regional Committee to complete part 2 of the EI form
Excellence Initiative Representative

First NameLast Name
Excellence Initiative Rep Email
example@kairos.org.au
Excellence Initiative Rep Phone
Please enter a valid phone number.Format: 0000-000-000.
Which Region is the EI Representative from?

Step 2: Review

Complete this section as soon as all information is available. Comments are required for all "No/Partly" answers. Give details.
Are all Regional Committee positions filled? If one member holds two positions, give details.
If no, please provide details
If a member holds two positions, please provide details
Was the Weekend Leader endorsed by the Regional Committee?
If yes, please provide date endorsed by Regional Committee

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate of State Council Meeting
If no, please provide reason below
Was the Weekend Leader endorsed by the State Council?
If yes, please provide date endorsed by State Council

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate of State Council Meeting
If no, please provide reason below
Has the Leader attended the Advanced Kairos Training (AKT)? within the required time?
If yes, please provide date of the AKT session

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
If no, please explain why the Leader did not attend AKT

Step 3: Weekend Information

Complete this section as soon as all information is available and submit prior to start of Weekend.
Leader Name

First NameLast Name
Leader Email
example@kairos.org.au
Leader Phone
Please enter a valid phone number.Format: 0000-000-000.
Leader Personal Email
example@example.com (if required)
Advising Leader Name

First NameLast Name
Advising Leader Phone
Please enter a valid phone number.Format: 0000-000-000.
Advising Leader Email
example@example.com
Observing Leader 1 Name

First NameLast Name
Observing Leader 1 Phone
Please enter a valid phone number.Format: 0000-000-000.
Observing Leader 1 Email
example@example.com
Observing Leader 2 Name

First NameLast Name
Observing Leader 2 Phone
Please enter a valid phone number.Format: 0000-000-000.
Observing Leader 2 Email
example@example.com
Additional information from the KSO:
This is the end of part 1. Part 2 of the Excellence Initiative Form will be sent to you prior to the start date of the Weekend. Please click on the Submit button below to send this form to your EI State Administrator.
Should be Empty:

Kairos Outside: Excellence Initiative Report - Pre Program

To be completed and submitted prior to the start of the Weekend

Step 1: Contact Information

Excellence Initiative Representative

Step 2: Review

Step 3: Weekend Information

This is the end of part 1. Part 2 of the Excellence Initiative Form will be sent to you prior to the start date of the Weekend. Please click on the Submit button below to send this form to your EI State Administrator.