National 4-H Conference

Delegate Application

DUE: October 3, 2016 Send to: Kansas State 4-H Office

201 Umberger Hall, KSU

Manhattan KS 66506-3404

To apply, ALL of the following must be in the State 4-H Office by October 3:

£  This application page

£  A cover letter introducing yourself and explaining why you want to be a National 4-H Conference delegate (one page maximum)

£  A résumé highlighting relevant experiences, skills, awards, etc. (one page maximum)

£  Two recommendation forms and letters of reference completed by an Extension Agent or/and 4-H Volunteer not related to the applicant. Recommendations should be mailed separately by the evaluator.

Applicants will be notified by November 1 if they have been selected to interview at the Kansas Youth Leadership Forum.

First Last Name
County/District
Mailing Address
Street City ST Zip
E-mail Address
Home Phone / Year in School / FreshmanSophomoreJuniorSeniorCol. Freshman
Mobile Phone / Age Jan. 1, 2016
Yes No / Will you be attending the 2016 Kansas Youth Leadership Forum? (Required)
Yes No / Have you completed the Volunteer registration process with your local Extension Office? (Required prior to Citizenship in Action)
Yes No / Have you served on any Kansas State 4-H Action Teams or other state-wide leadership groups? If yes, please list below:

I recommend the youth named above as Kansas delegate for National 4-H Conference. I believe this individual is trustworthy, respectful, responsible, fair, and a caring citizen who will be an actively contributing team member for this conference. My signature indicates my support for their application and verifies that if this member is selected, they will have completed the Volunteer Registration process in our county/district prior to the 2017 Citizenship in Action event.

Extension Agent’s Signature Date

National 4-H Conference

Delegate Agreement Form

If I am selected as a Kansas youth delegate to National 4-H Conference, I agree to the commitments listed below:

1.  Provide $1300.00 toward National 4-H Conference fees by February 1. The remaining expenses are paid by a grant through the Kansas 4-H Foundation. Often times your 4-H Club, 4-H Council, local 4-H Foundation or other community organizations will help to fund your fee.

2.  Serve two years on the Kansas 4-H Youth Leadership Council. I agree to attend the Kick-Off Retreat January 7-8, 2017 when my term begins.

3.  Participate in orientation prior to National 4-H Conference (usually held in conjunction with the Youth Council retreat in January). I realize I will not receive reimbursement for travel to the orientation site.

4.  Represent Kansas 4-H to the best of my ability at National 4-H Conference; sharing ideas from Kansas and learning ideas from other states.

5.  Assist with the Citizenship in Action, Kansas Youth Leadership Forum, Emerald Circle Banquet, Friends of 4-H Day, Campference, Kansas State Fair and/or other state 4-H events as requested.

6.  Take initiative in helping 4-H members become more involved in Kansas 4-H Program activities and decisions.

Signature of Applicant Date

Signature of Parent or Guardian Date

NOTE: Applications will be screened and selected applicants will be notified by November 1 as to their invitation to interview. Interviews will be held on November 19, 2016 at Rock Springs 4-H Center in conjunction with the Kansas Youth Leadership Forum (attendance is required).

National 4-H Conference

Recommendation Form

Received by: October 3, 2016 Send to: Kansas State 4-H Office

201 Umberger Hall, KSU

Manhattan KS 66506-3404

You have been asked to provide a recommendation for a 4-H’er who is applying to serve as a National 4-H Conference delegate representing Kansas. To complete this reference, please send the following documents, separate from the 4-H’ers application to the State 4-H Office (address above) by Monday, October 1:

£  This recommendation form

£  A letter of recommendation explaining how you’ve worked with the applicant and their relevant skills and abilities. (one page maximum)

Applicant Name
Reference Name

Please check the column that best describes this youth’s characteristics.

Poor / Below Average / Average / Above Average / Excellent / Unknown
Optimistic/Positive Attitude
Work Habits
Organizes Time and Work
Interpersonal Skills
Listening Skills
Creative/Innovative
Tactful/Courteous
Dependability/Promptness
Maturity/Poise
Honesty/Integrity