North Carolina Ffa Association

NORTH CAROLINA FFA ASSOCIATION

Application for State FFA Degree

Application must be received in the State FFA Office no later than 5:00 pm on April 6th 2012 . Please mail to:

Mr. Jason Davis, State FFA Coordinator, North CarolinaStateUniversity, Box 7654, Raleigh, NC27695-7654.

Section One: Personal Data

NameJohn Doe ChapterSouthCountyFFA

Address123 Oak St.AnytownNC22222

Street or PO BoxCityState Zip

Email address: ______

Date of Birth8/26/83 Present Age17 Years of Ag. Ed. completed3

Year in school or year of graduationjunior Total active FFA membership in months36

Year Greenhand Degree awarded2000 Year Chapter FFA Degree awarded2001

Section Two: Candidate’s Involvement in FFA activities (to be completed by FFA Advisor)

• Has the candidate demonstrated skill in performing XYesNo

ten parliamentary procedure abilities?

• Has the candidate delivered a six minute speech onXYesNo

an agricultural topic?

• Has the candidate participated in the planning andXYesNo

completion of the chapter program of activities?

List FFA offices held and/or FFA committee participation of the candidate. / Level of FFA participation / Year
Junior Vice President / Chapter / 2000-01
Banquet Committee / Chapter / 2000-01
Reporter / Federation / 2002-03
Secretary / Region / 2002-03
List five (5) FFA activities above the chapter level that the candidate has participated in. / Level of FFA participation / Year
Tool ID CDE / State / 2000
National Convention / National / 2001
FFA Camp / State / 2001
FFA Children’s Barnyard / Federation / 2002
Fall Leadership Conference / Region / 2002

Section Three: Candidate’s Supervised-Agricultural Experience Program

Note:In sections A, B, and C on the back of the page – Complete only those which apply to your SAE.

Brief Description of the Candidate’s Supervised Agricultural Experience Program

John has two different SAE’s: honey bees and lawn care. John owns three stands of honey bees. He manages the stands and collects honey in the spring and in the summer. He packs the honey himself and sells it throughout his local community.

John also landscapes and mows his yard and his grandmother’s yard. He works throughout the year to maintain the landscapes. John plants flowers, prunes trees and shrubs, mows, and collects leaves. He is not paid for these hours of work.

A.Entrepreneurship

Net Worth Summary
Column A / End of First year/ Dec. 31, __1999___
Column B / End of First year/ Dec. 31, __2000___
Column C / End of First year/ Dec. 31, __2001___
Column D / End of First year/ Dec. 31, __2002___
Column E / End of First year/ Dec. 31, _____
Column F

1. Total Income

/ $375 / $560 / $480 / $695

1. Total Expense

/ $424 / $279 / $168 / $212

1. Net Income

/ $-49 / $281 / $312 / $483

1. Amount

Productively
Invested / $0 / $170 / $210 / $380
Total Amount Productively Invested (Sum of line 4 in columns B through F). $ 760

B.Placement

Year / Job title or Type of Work / Total Hours Worked / Gross Earnings / Total Expenses / Net Earnings
Unpaid / Paid / Total
1999 / Landscaping / 38 / 38 / $0 / $0 / $0
2000 / Landscaping / 110 / 110 / $0 / $0 / $0
2001 / Landscaping / 134 / 20 / 154 / $100 / $0 / $100
2002 / Landscaping / 95 / 32 / 127 / $160 / $0 / $160
TOTALS / 377 / 52 / 429 / $260 / $0 / $260

C.Analytical / Experimental

Year / Description of Research/ Analytical Activity / Summary of the Results / Total Hours Worked
(Use additional pages of necessary) / (Use additional pages of necessary)

Minimum Qualifications: The candidate must have earned and productively invested $1,000 or worked at least 300 hours in excess of scheduled class time, or a combination thereof, in a supervised agricultural experience program. Records to substantiate the above figures may be requested by the State FFA Coordinator.

Section Four: Community Service

Activity / Number of Hours
Road Side Clean Up / 8
PALS Program / 17

Minimum Qualifications: The candidate must have participated in two projects totally atleast twenty

Section Five: Certifications

• I hereby certify that the candidate has a satisfactory scholastic record. SIGNED

Principal (Signature)

• We hereby certify that the statements on this application are true, accurate and complete and we are able to recommend the candidate for the State FFA Degree.

SIGNEDSIGNED

Chapter Advisor (Signature)Chapter President (Signature)

• We hereby certify this application to be true and accurate.

SIGNEDSIGNED

Parent or Guardian (Signature)Candidate (Signature)