St. Charles Parish 4-H Senior Jacket Application

ST. CHARLES PARISH 4-H SENIOR JACKET APPLICATION

In order to be considered to receive a St. Charles Parish 4-H SENIOR JACKET in recognition for your hard work and dedication to the 4-H club program, you must meet the following qualifications:

A 4-H club member for 4 years of high school, including this current year
Participate in at least 1 parish or state 4-H event per year for 4 years of high school, including this current year
Answer all of the following questions to the best of your ability

*In the event the 4-H member does not participate in 4-H during his/her senior year, he/she will be responsible for the cost of the jacket.

COMPLETE ALL QUESTIONS BELOW:

Name: ______Jacket Size (Adult size): ______

Complete the table below by placing a check in the boxnext to each 4-H event in which you participated during your specified year in high school. (Place a check in the 12th grade box if you already qualify for the event. Place a  in the box if you have plans to qualify for the event. All events will be verified by the 4-H Agent.)

EVENT / 9th grade / 10th grade / 11th grade / 12th grade
Parish Jr. Leader Club (must be eligible for Jr. Leader Summer Awards Trip to receive credit)
Parish Shooting Sports Club (must have completed 8 hours of training in at least one discipline to receive credit)
Parish Fashion Club (must have participated in a 4-H Fashion Contest to receive credit)
4-H Fun Day (must have attended event to receive credit)
4-H Project Day (must have attended event to receive credit)
4-H Contest Day (must have attended event to receive credit)
4-H Achievement Day (must have attended event to receive credit)
4-H University(must have attended event to receive credit)
Citizenship Washington Focus (CWF) (must have attended event to receive credit)
Junior Leadership Conference (JLC) (must have attended event to receive credit)
Camp Counselor(must have served as a 4-H Camp Counselor to receive credit)
State Co-op conference (must have attended event to receive credit)
Marsh Maneuvers(must have attended event to receive credit)
State Records(must have participated in event to receive credit)
District or State Livestock Show(must have participated in event to receive credit)
District or State Horse Show(must have participated in event to receive credit)
State 4-H Board(must have served on the board to receive credit)
Other: ______

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In 50-75 words, describe how 4-H impacted your life.

List at least one state 4-H event in which you participated throughout your 3 years of high school. Describe what you did for that event including what you learned by participating in that event.

Explain what you will remember most about your experience in 4-H.

Would you like to be a 4-H volunteer after you graduate? (Circle one.)

YESNO

If yes, what is the best way to contact you regarding volunteering?

Do you have any suggestions for improvement of the 4-H program? If so, please describe.

I, ______, acknowledge that I have personally prepared this application and believe it to be true and understand and agree upon its conditions.

______

Signature of 4-H memberSignature of Parent/Guardian