Dear 4-Her,
The Members Evaluation (ME) form is a very important tool that is one piece used to award you with a possible trip or award. Please take time fill out this form COMPLETELY and NEATLY! It is your time to show off everything you have done in
4-H!
As you fill out the form please remember the following hints:
1. Must be currently in 7th grade or above to complete the ME Form.
*Note for 6th graders & Space Camp Applicants: There is a separate form to complete for Space Camp. (See last page of ME) 6th graders may only apply for Space Camp. If you are applying for Space Camp please complete that form/page. 6th graders it is the only form you will complete. 7th-8th graders it will be in addition to the ME Form.
2. Completely fill out the form.
a. TYPED/COMPUTER GENERATED - Forms that are typed or computer generated are typically neater than handwritten forms. Points are lost for hard to read forms.
b. Do Not Use Pencil! – If handwritten is the only option, complete in pen. points are lost for writing in pencil!
3. Make a rough draft! - Write your thoughts on a rough draft copy. Revised and edit. Write clearly. Be concise.
4. Edit it! – Have a parent or leader proof it before turning it in! You can quickly loose points for grammar and spelling mistakes.
5. Do not add pages! –
a. The form itself is only 5 pages long (3 if you are just applying for Space Camp). This is just a summary of all the leadership experiences you’ve had. Please keep pages one sided.
b. Do not change formatting or move boxes to different pages. Information must fit the boxes allowed.
6. Stick to the Due Date! - Return with proper signature by due date. Points will be deducted for late entries.
7. Extra Points – Want 10 extra points? Attend the ME /Interview Workshop. September 27, 6:30-8:00 PM @ 4-H Office.
If you have any questions, please ask. We are happy to help you.
Happy writing!
Langlade County 4-H Awards Committee
A. List up to 4 projects you have been enrolled in and supply the requested information. List recent ones first. Please provide a detailed explanation of your involvement.
Do not include youth leadership in this section.
Project / Years Enrolled(ex: 2012-2014) / What did you gain through your involvement in this project?
(Learned, Appreciation, Shows/Workshops Attended, Volunteer, Goals)
(Please be concise. Do not add pages.)
B. List officer and committee positions you have held.
Please indicate if you were a committee chair.
Offices or Committees / Years Participated(example: 2012-2016)
Offices: (ex: Club President, Poultry Committee Secretary, etc. Include: Club, County, State, & National)
1.
2.
3.
4.
Committees (ex: Club Halloween Committee, Rabbit Committee, Fundraiser Committee, etc.
Include: Club, County, State, & National)
1.
2.
3.
4.
C. List 4-H activities you have been in.
This area is for other activities not listed in this form already. Focus on activities where you had a leadership role first. List recent activities first.
(ex: 4-H Art Beat, Ice Cream Social)
Activities / Leadership Roles in this Activity / Years Participated(example: 2012-2016)
(Please be concise. Do not add pages.)
D. Describe two leadership roles and experiences that you are particularly proud of that you have had on the club, county, district, or state level.
Activity #1 / Leadership Roles, Trainings Attended, &Experiences in this Activity
Activity #2 / Leadership Roles, Trainings Attended, &
Experiences in this Activity
E. List Non 4-H activities (ex: church, school, sports, and any other clubs/organizations).
Activity / Leadership Roles in this Activity / Years Participated(ex: 2010-2014)
Name ______Club______
Address ______
Email ______
Why do you want to attend Space Camp? (100 words or less)
What do you hope to learn by attending Space Camp? (150 words or less)
What has been your favorite 4-H experience so far? (100 words or less)
TRIP & AWARD
PREFERENCE FORM
What county sponsored trip/award have you previously participated in?
· Indicate year of trip or award.
Trip/Award / Year / Trip/Award / YearWI 4-H Youth Conference / American Spirit Trip
Citizen Washington Focus / Key Award
National 4-H Congress / National 4-H Conference
Space Camp
Which trip or award are you applying for?
· Note Requirements. Only apply for those which you are eligible. If you have questions please ask before turning in application.
· All applicants must be enrolled in the Youth Leadership Project
· Rank in order of preference. (1=First Choice; 2=Second Choice; etc. )
Rank / Trip/Award / RequirementsSpace Camp / 6th-8th Grade at time of selection
Date: April 26-30 2018
WI 4-H Youth Conference / 7th-10th Grade at time of selection
Date: June 25-28, 2018
American Spirit / 8th-10th Grade at time of selection
Date: Early June 2018
Citizenship Washington Focus / 10-12th grade at time of selection. Minimum age at trip: 15 years
Date: June 16-23 2018
Key Award / 16 years or older
Member for at least 3 years
National 4-H Congress / 10th-12 grade at time of selection
Date: November 23-27, 2018
National 4-H Conference / 10th-12th Grade at time of selection.
Maximum age as of Jan. 1, 2017: 18 years
Date: April 6-12 2018
**Note: 4-Hers will be required to pay for approximately 30% of the cost of the trip. If the 4-Her is unable to attend the trip and the paid fees are non-refundable, the 4-Her will be responsible to pay that amount to the Leaders Association. Exceptions may be made by the Board of Directors in case of illness, family emergencies, etc.
Parent/Guardian Endorsement:
I feel that my child, ______, has stated the information in this "Short M.E. Form" accurately, and should be considered for selection by Langlade County 4-H for an award/trip.
Signed ____ Date ______
General/Project Leader Endorsement:
I feel confident that this 4-H member has stated the information in this "Short M.E. Form" accurately, that they have the minimum number of required permanent points, and should be considered for selection by Langlade County 4-H for an award/trip.
Signed______Date ______