Kairos Torch Online Weekend Leader's Report

Fill out this form to report Torch Weekend to the KPMI Torch program Coordinator, Kevin Resnover. He will forward this report to your State Chapter Committee Chairperson and your Advisory Council Chairperson.

Torch Identification

Your Name:
Address (City, State, ZIP):
Your E-mail Address:
Phone Number:
Institution:  #:  State:
Weekend Dates:

Team Identification

# Inside Team Members:   # Support Team Members:   # Runners:
# 1st Time Team Members:   # Veteran Team Members:       % New:
# Assigned Jobs:

# Caucasian:   %:                                                                                           
# Hispanic:   %:                                                                                           
# African American:   %:                                                                                           
# Asian:   %:                                                                                           
# Native American:   %:                                                                                           
# Other:   %:                                                                                           
# Total Team Members:                                                                                           

# Assembly of God:   %:                                                                                           
# AME:   %:                                                                                           
# Baptist:   %:                                                                                           
# Catholic:   %:                                                                                           
# Church of Christ:   %:                                                                                           
# Episcopal:   %:                                                                                           
# Independent/Bible:   %:                                                                                           
# Lutheran:   %:                                                                                           
# Methodist:   %:                                                                                           
# Pentecostal:   %:                                                                                           
# Presbyterian:   %:                                                                                           
# Other Denomination:   %:                                                                                           

Team Member Info (Please use the following format):
     Name (* = New Team Member)
     Address
     Phone Number
     E-Mail Address
     Weekend Job Assignment
     Willing to Mentor (Yes or No)

Team Member #1:


Team Member #2:


Team Member #3:


Team Member #4:


Team Member #5:


Team Member #6:


Team Member #7:


Team Member #8:


Team Member #9:


Team Member #10:


Team Member #11:


Team Member #12:


Team Member #13:


Team Member #14:


Team Member #15:


Team Member #16:


Team Member #17:


Team Member #18:


Team Member #19:


Team Member #20:


Team Member #21:


Team Member #22:


Team Member #23:


Team Member #24:


Number of Table Families:
Participant Demographics:

                           Caucasion:
                            Hispanic:
                African American:
                                 Asian:
                  Native American:
                                 Other:

Total Number or Participants:

Participant Identification (* if the participant will be mentored):

  Participant 1 Name:
  Participant 2 Name:
  Participant 3 Name:
  Participant 4 Name:
  Participant 5 Name:
  Participant 6 Name:
  Participant 7 Name:
  Participant 8 Name:
  Participant 9 Name:
Participant 10 Name:
Participant 11 Name:
Participant 12 Name:
Participant 13 Name:
Participant 14 Name:
Participant 15 Name:
Participant 16 Name:
Participant 17 Name:
Participant 18 Name:
Participant 19 Name:
Participant 20 Name:
Participant 21 Name:
Participant 22 Name:
Participant 23 Name:
Participant 24 Name:
Participant 25 Name:
Participant 26 Name:
Participant 27 Name:
Participant 28 Name:

Agape and Stewardship:

Total Income Received:
In-Kind Income:
Total Expense:

Your Comments for Newsletter:


Leader's Assessment of the Weekend:


Leader's Feedback on using this Electronic Weekend Leader's Report:



Refresh Image

Anti-SPAM Code (not case sensitive):