Choose Option 1 Or 2 to Apply for This Award

• Staple this form to each application form with your support materials due to the office no later than 12:00 PM on October 2
• Interviews will be held on Tuesday, October 17, 2017 beginning at 5:00 p.m. and Thursday, October 19, 2017 beginning at 5:00 p.m. Please indicate a date on which you would be available for an interview and an e-mail address where we can reach you in case we need to arrange an alternate time.
• Tuesday, October 17 ______
• Thursday, October 19______
• Either ______
• E-Mail Address______
• Criteria for selection are level of involvement, achievement and learning.

Choose option 1 or 2 to apply for this award.

Option 1

Use the appropriate statements for the award you are applying for as a guide in presenting information that shows your work in that award. You can submit up to five pages of writing, photos, clippings, or other means to tell your story.

Option 2

Use the information on this form as a guide, audio or video tape your application. There is a 12 minute limit for audio or videotapes.

Check the award for which you are applying.

____ Leadership: There are three different leadership categories for senior level members. From one application and interview, awards can be given in each category. Leadership is where you have been in charge of a program, activity or group, and involved others in carrying out the goals.

Explain the leadership experiences you’ve had in the past four to eight years. What have those experiences have meant to you and others in the community? How have you tried to live the 4-H pledge and motto?

• I Dare You. This award is for high school juniors who have demonstrated personal integrity, leadership, well-rounded lives and possessed a willingness to assume responsibility.
• County Leadership. This award is for senior level members who have exhibited a long-term commitment to providing leadership in their club, school, church, and/or community.

____ Citizenship:Citizenship is a 4-H value because it is a commitment to active participation, leadership, and community service.

Explain the citizenship experiences you’ve had in the past four to eight years and what those experiences have meant to you and others in the community.

____ 4-H Life Skills: This award is for 2017 high school graduates. Applications are due October 2; interviews will be scheduled.

Explain the experiences you had in 4-H and what 4-H has meant to you. Explain how you plan to continue the values and life skills you’ve learned in 4-H.

12/25/2018