2018 CalumetCounty4-H Trips
ApplicationPacket
Grades 6-8** for the 2017-2018school year
All materials due Monday, October 16, 2017
Interviews are
*** New Date*** - Wednesday, November 1, beginning at 6:00pm
Room #018
Courthouse, Chilton
**Thisapplicationpacketisforyouthingrades6-8whoareapplying for SpaceCamp.
Thispacketcontainsnecessarypiecesofyourapplicationand additionalresources:
Page1:OverviewofSpaceCamp
Page2:Instructionsforcompleting application
Pages3-4:Application
Page5:AdultRecommendation(non-relative)froma4-Hreference
Page6:AdultRecommendation(non-relative)fromanon4-Hreference(teacher,communityleader,etc.)
Page7:TripsandAwardsSelectionPolicy
Page8:ApplicationFollow-up
Applicationswillbe accepted hard copyorviaemailwith electronicsignatures.
Ifyouhave a preferenceforan interviewtime,or have anyquestionsregardingrésumésorthe application process, please contactTami at 920-849-1450 x1 .
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2018CalumetCounty 4-H TripsApplication
Grades 6-8 for the 2017-2018 School year
Fillingoutthispacketwillmake youeligible fora scholarship for the followingtrip:
Space Camp
4-H members may apply for a fun-filled weekend at the U.S. Space and Rocket Center in Huntsville, Alabama. The tentative dates are in April 26-30, 2018. Delegates team up for hands-on mock space missions and other STEM activities in this NASA program while exchanging ideas with 4-H youth from across Wisconsin.
Qualifications: Currently in grades 6-8; maximum age 15 at time of trip.
Cost: Approximately $625
- Calumet 4-H Scholarship - $100/youth
An EEO/AA employer, University of Wisconsin-Extension provides equal opportunities in employment and programming, including Title VI, Title IX, and the Americans with Disabilities Act (ADA) requirements. Requests for reasonable accommodations for disabilities or limitations should be made prior to the date of the program or activity for which it is needed. Please do so as early as possible prior to the program or activity so that proper arrangements can be made. Requests are kept confidential.
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Printneatlyusing a blue or black pen or type formon computer. Applications completed in pencil will not be accepted. Donotaddanyextralines orpages. Completeeachsection asdescribedinthe sectionsbelow. If youhavequestions, please calltheUWEXoffice at920-849-1450.
NAMEEDUCATION / Filloutthe appropriate lines4-H PROJECT SUMMARY / Listthe mostrecentprojectsyouhavebeenenrolled in, thenumber of years, andif you are currentlyenrolledinthem.
4-H CLUB,COUNTY OTHERACTIVITY INVOLVEMENT
/ Listthe 4-Hactivitiesyouhaveparticipatedinon the club, regional, state,andnationallevelandinclude the number of yearsinvolved.4-HCOMMUNITY SERVICE / Listordescribe yourcommunityservice withinyour cluband/or countyandwhatyou did.
FAVORITE4-H ACHIEVEMENT / Describeor write about a4-Haccomplishment or leadershiprole thatyou are mostproudof andwhy.
NON4-H ACTIVITIES / List your activitiesoutside of4-Handthenumber of years youhave beeninvolved.
Checkthetripsandawardsyouare eligible andinterestedinapplyingfor. Once yourformiscomplete,signyour name, have yourparent/guardiansign,andhave your4-Hclubleadersignthebottom. Return your formto the CalumetCountyUW-ExtensionofficebyOctober16, 2017.
PLEASEDONOTADDEXTRALINESORPAGES!!
Applicationswillbejudgedbasedonneatness,quality,gradelevel,andcompleteness.
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2018 Calumet County 4-H Space Camp Application
Thisapplication should betyped orcompleted usingablueorblack pen. Applicationscompleted in pencilwillnotbeaccepted!
Name:Address:
City, State, Zip:
Phone Number:
E-mail:
Education - School Name: / Grade (2017-2018):
4-H Club Name: / # Years in 4-H:
4-H PROJECT SUMMARY / 4-H Projects / # YearsEnrolled / CurrentlyEnrolled(Yes/No)
4-H CLUB, COUNTY & OTHER 4-H ACTIVITY INVOLVEMENT / 4-H Activities
Ex: Camp,DemonstrationContest, Club Fundraiser / # Years
COMMUNITY SERVICE / CommunityServiceDescription
Ex: Bingo at thenursing home,collectingschool supplies, etc. / # Years
FAVORITE4-HACHIEVEMENT / Describe or writeabout a4-H accomplishment or leadershiprole thatyouaremost proud of andwhy:
NON 4-H ACTIVITIES / Other Activities
Ex: School,Church, Sports, etc. / # Years
Name ofperson whowillcompleteyour 4-Hreference form:
Name ofperson whowillcompleteyournon 4-Hreference form:
Applicationswillbe accepted hard copyorviaemailwith electronicsignatures.
4-Hmembersignature / Parent/GuardianSignature / 4-HClubLeaderSignatureBE CONCISE! DONOTADD LINES OR PAGES – Page 2 of2
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Calumet County4-HLeadersCouncil
206CourtSt
Chilton,WI53014
920-849-1450
4-H REFERENCEFORM
Nameof4-HMember:Aspartof the processforselectingyouthforCalumetCounty4-HTrips,theselectioncommitteeisseeking recommendation and informationforeachcandidate.Pleaseprovideusyourinput,tothe bestofyourability,regarding thefollowingareas:
Excellent / Good / Fair / Poor / Unknown- Leadershipqualities
- Maturity
- Participation in4-H program
- Responsibility
- Positive attitude
- Willpositivelyrepresentthe4-Hprogram
Please provide additionalcommentsinthe spacebelow:
PrintYourName: / Title:Signature: / Date:
PhoneNumber:
Email:
Pleasereturnthisform to theaddressabove or e-mail to byOctober16, 2017.
THANKYOU!
UniversityofWisconsin,U.S.DepartmentofAgricultureand Wisconsincountiescooperating.AnEEO/AA employer,UniversityofWisconsinExtension providesequalopportunitiesinemploymentand programming,including TitleIXand Americanwith Disabilities(ADA)requirements.
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Calumet County4-HLeadersCouncil
206CourtSt
Chilton,WI53014
920-849-1450
NON4-HREFERENCE FORM
Nameof4-HMember:Aspartof the processforselectingyouthforCalumetCounty4-HTrips,theselectioncommitteeisseeking recommendation and informationforeachcandidate.Pleaseprovideusyourinput,tothe bestofyourability,regarding thefollowingareas:
Excellent / Good / Fair / Poor / Unknown- Leadershipqualities
- Maturity
- Responsibility
- Positive attitude
- Willpositivelyrepresentthe4-Hprogram
Please provide additionalcommentsinthe spacebelow:
PrintYourName: / Title:Signature: / Date:
PhoneNumber:
Email:
Pleasereturnthisform to theaddressabove or e-mail to byOctober16, 2017.
THANKYOU!
UniversityofWisconsin,U.S.DepartmentofAgricultureandWisconsincountiescooperating.AnEEO/AA employer,UniversityofWisconsinExtension providesequalopportunitiesinemploymentand programming,including TitleIXand Americanwith Disabilities(ADA)requirements.
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CalumetCounty4-H Trips and AwardsSelectionPolicy
January2016
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1.Theopportunitytoapplyfora4-Htrip scholarshipor 4-HKey Award isopentoallyouthmeetingmembershipandageeligibilityrequirementsforatriporawardregardlessofrace,color,creed,religion,sex,nationalorigin,disability,ancestry,sexualorientation,pregnancy,maritalstatusorparentalstatus.
2.You are required to participate in an interview if one or more of the following applies:
•applyingforatrip scholarship
•applying for Key Award
•want to participate in the following limited space events:
•American Spirit
•CWF
Allapplicantswillbenotified of their scheduledinterview date and time. Intheeventtheapplicantcannotattend in person,a phone orSkypeinterviewwillbeprovidedifthe requestismadeatleast7dayspriortotheir interviewdate.
3.Iftherearemoreapplicantsthantherearepositionsforatrip,applicantswillberankedbasedon theirapplicationsandinterviews.Rankingwillbebasedonascoringrubriccompletedbytheselectioncommittee.
4.Iftherearemoreapplicantsforatripthantherearescholarshipsavailable, applicants willbe rankedbasedonthe application andinterview.Ranking willbebasedonascoringrubriccompletedbytheselectioncommittee.
5.Alltripandawardapplicantswillreceivewrittenfeedbackabouttheirapplicationandinterviewwithintwoweeksoftheselection/interviewdate. When available, trip registration information will be sent to participants.
An EEO/AA employer, University of Wisconsin-Extension provides equal opportunities in employment and programming, including Title VI, Title IX, and the Americans with Disabilities Act (ADA) requirements. Requests for reasonable accommodations for disabilities or limitations should be made prior to the date of the program or activity for which it is needed. Please do so as early as possible prior to the program or activity so that proper arrangements can be made. Requests are kept confidential.
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I finishedfilling outmyapplication…nowwhat?
- Make a copy of your applicationand keeponefor yourself. If your application is hand written,besure to submit the original copy.
- Follow up with your two references to confirm they have completedyour reference forms and sent them to the UW Extension office.
- Onceall application materials have been receivedand theOctober 16 applicationdeadline has passed, you will receive a letter from the UW Extension indicating a date and timefor your interview.
- Preparefor your interview by selecting appropriateattireandthinking about how you will describe why you deserve to participate in the trip(s) you areapplying for.
- Arrive10-15 minutesearlyfor your interview.
- If selectedfor a trip, mark the dates of the trip onyour calendar.
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