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APPLICATION FOR COLUSA COUNTY 4-H COUNCIL
JR./TEEN LEADER MERIT AWARD
TO THE STATE 4-H CONFERENCE
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DUE IN THE 4-H OFFICE - April 3rd
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NAME
_____ ______CLUB____________________
PHONE NUMBER___________________ EMAIL
AGE (AS OF DEC. 31ST)
ADDRESS_______________________________
GRADE IN SCHOOL
YEAR IN JR./TEEN LEADERSHIP
YEAR IN 4-H____________
PROJECT OR ACTIVITY
MY JR./TEEN LEADER ADVISOR IS
_
_______
___
CURRENT STAR RANK:
ELIGIBILITY:
Any Jr./Teen Leader who has satisfactorily completed one or more years
of Jr./Teen Leadership. Will be a Freshman or older next fall, and has
his/her project leader's and key leader's approval.
PROCEDURE:
1.
Sign this completed application and return it to the 4-H Office by
April 3rd along with your up-to-date Record Book, signed by the
Key Leader.
2.
You will be notified in writing of your interview date and time.
3.
Please attach a one page story highlighting your Jr/Teen Leader
experiences; what you have learned; and how you have served
your 4-H community.
Project Leader's Signature of Approval:
Key Leader's Signature of Approval:
__
___
Good Luck,
Liz Dawley
4-H Program Representative
Colusa County
UCCE Colusa County • 100 Sunrise Blvd., Suite E • Colusa, CA 95932
Office 530.458.0570 • Fax 530.458.4625 • Email: cecolusa@ucdavis.edu • Website://cecolusa.ucanr.edu