2015-2016

Carlisle County FFA Chapter

Officer Application

Name: ______FFA Chapter: ______

Birth date: ______Degree:______

Address: ______

Describe the importance of the FFA to you, and why you want to be an FFA officer: ______

______

Applicant Signature: ______

Parent Signature: ______

Advisor Signature: ______

Principal Signature: ______

RECORD OF FFA PARTICIPATION

Name: ______FFA Chapter: ______

Age:______Date of Birth: ______

Parent’s Name:______Address:______

Telephone # :______

Email: ______Date FFA Membership Began: ______

Home environment (check one) [ ] Farm; [ ] Rural/ Non-Farm; [ ] Suburban/Subdivision; [ ] Urban/City

Check type of Supervised Agriculture Experience Program (check one):

[ ] Production Entrepreneurship[ ] Agribusiness Entrepreneurship[ ] Agriscience

[ ] Production Placement[ ] Agribusiness Placement (e.g. agri-research,

environmental and/or

Other SAE Involvement (check where appropriate):natural resources)

Improvement Projects:[ ] Home;[ ] Farm;[ ] Environmental

Supplementary Practices: [ ] Farm;[ ] Agribusiness;[ ] School Laboratory Based SAE

(beyond normal class hours)

ffa leadership Record
Degree Advancement / Chapter Offices / Region & State Offices
Date Received / Year / Office / Year / Office / Year
Greenhand
Chapter Degree
State Degree
COMMITTEE WORK
(Include chapter, regional, state, and national committees)
Year / Committee / Chair/Secretary/Member
LEADERSHIP IN SCHOOL AND COMMUNITY ACTIVITIES OTHER THAN FFA
(List an activity only ONCE)
Year(s) / Activity/Organization / Level of Participation
(Local/Regional/State/National) / Offices, Awards
Length of Service

RECORD OF PARTICIPATION IN FFA ACTIVITIES

Record your participation in local, regional, state, and national FFA activities and contests. (Examples: National or State Conventions, FFA Leadership Training Center, Kentucky State Fair, MFE Conferences, Public Speaking, Impromptu Speaking, proficiency contests, judging contests, local and regional fairs, livestock shows, FFA local and regional banquets, University FFA Field Days, etc.)

List an activity only once. List years under appropriate column and use multiple check marks under level of

participation for number of years.

School
Year(s) / Activity / Level of Participation
Local | Reg. | State | Nat’l / Results, Awards, Responsibilities,
Placing, or Participation

Revised 02/99

Signed: ______

FFA Member