2017-2018 State 4-H State Shooting Sports Teen Ambassador Board

Applicant Information Form

Please fill out the following information completely. Check it for accuracy. All forms should be sent to Donna Fox atthe 4-H State Office via the County 4-H Agent to ensure the correct submission of delegates. Check the events listed to make sure you can make the commitment of being a 4-H Shooting Sports Teen Ambassador. Ambassadors serve a one-year term. All applicants must be 15-17 (by 4-H age) to be eligible to be an Ambassador. Please contact your agent if there are any questions.

First Name: / Last Name: / Birthdate:
Street Address: / County:
4-H District:
City: / Zip Code:
Home Phone: / Cell Phone: / Email:
Polo/T-Shirt Size: Small Medium Large XLarge XXLarge XXXLarge
4-H Age (as of Jan. 1st): Years in 4-H:
Attended State Shooting Sports Camp: Yes ____ No ____ Attended 4-H Camp: Yes ____ No ____
Please list 4-H Shooting Sports Teen Leader certifications:
Are you currently a Shooting Sports Ambassador? / YES / NO
Required Meetings/Events: / Ambassadors must attend a minimum of two State Shooting Sports Committee meetings; two Coach’s certification workshops; Shooting Sports Camp; Shooting Sports State Competition; one State Teen Council meeting; State Teen Conference; Volunteer Forum (every other year). A written letter of explanation MUST be submitted to the Specialist for any missed event. Missing three events may result in being removed as an Ambassador.
Parents Signature:
______
Agent Signature:
______
Shooting Sports Club Coordinator/Coach signature: / Much of the correspondence is conducted via email or through messages on Facebook. ALL meeting or event registrationsare also sent through standard mail. Ambassadors are strongly encouraged but not required to make use of email and the AmbassadorFacebook (monitored & closed to outside groups) with the permission and knowledge of their parents.
Agents and parents should sign to the left of this box to indicate agreement and that the 4-H member is in good standing. Incomplete applications will not be accepted.
Shooting Sports Coordinator/Coach should sign to the left to confirm applicant’s involvement in the club and Teen coach certification.

Review the Ambassador Fact Sheet for eligibility and program details.

Name of Applicant: ______

Essays (required-Must be typed)

  1. Think about your strengths. How do you think these strengths can contribute to our 4-H Shooting Sports Ambassador Program and why should you be selected as an Ambassador?

______

______

______

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  1. In what ways do you think you can impact the youth in Kentucky by becoming a 4-H Shooting Sports Ambassador?

______

______

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______------(Attach an additional page as needed for your answers.)

Attach a picture of yourself with the application.

Thank you for applying to the Kentucky 4-H Shooting Sports Teen Ambassador Board. The completed application with all accompanying signatures and essay should be sent to the following address between March 1andMay 1, 2017:

State 4-H Office

Attn: Shooting Sports Extension Specialist

212 Scovell Hall, Lexington, KY 40546