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/ 4-H Volunteer Awards

Cover Sheet
MD 4-H Hall of Fame Award / Submit completed forms to:
Linda Walsh
Maryland 4-H Center
8020 Greenmead Drive
College Park, MD 20740
Fax: 301-314-7146
Email:

To nominate a 4-H volunteer please follow these instructions:

1) Read all the award descriptions to determine which specific award will best recognize your volunteer’s contributions to the 4-H Program.

2) Fill out the following award nomination form carefully, being sure to provide the correct information as it relates to that award. Please be aware that the Awards Committee reserves the right to move a nomination to a different category, in order to better recognize a volunteer’s work.

3) Complete this cover sheet with your contact information. Send both this cover sheet and your nomination form to the stated address.

4) Please remember to save your nomination and resubmit it with updates the following year if the volunteer is not chosen the first time.

Your Name: ______County/Unit: ______

Complete Address: ______

______

Phone: ______Email: ______

Authorization:

I believe the information submitted in this nomination to be accurate to the best of my knowledge.

Signature: ______Date: ______

Permission Release:

I______, give my permission for the information contained in this awards nomination to be used as an example for others completing future award nominations. I understand that all or part of the nomination could be published on websites, promotional materials, or shared in variety of media. Please be aware that no awards information will be shared without consent of the author as well as the award winner.

Signature: ______Date: ______

MD 4-H Hall of Fame Award Nominee’s Name:

______

.

/ MARYLAND 4-H HALL OF FAME
Award Nomination Form / Questions? Contact:
Dr. Lisa Dennis

OR
Wendy Sites

A nominee for the Maryland 4-H Hall of Fame should exhibit outstanding citizenship, leadership, career accomplishments and character. This individual will show ceaseless dedication to 4-H at all levels of involvement, with exemplary efforts to 4-H program development. The winner of this award will be the Maryland nominee to the National Hall of Fame Award. (Please read all directions for this nomination carefully as it will be used to send to the national competition, if selected.)

The National 4-H Hall of Fame was created in 2002,as a 4-H Centennial project, to recognize and celebrate those people who have made a significant impact on 4-H and its millions of members over more than 100 years.

Nominee Information

Name ______

Relative/contact person if nominee is deceased ______

Mailing Address ______

Town/City ______State _____ Zip ______

Telephone ______email ______

Nominator Information

Name ______Telephone ______

Address ______

Town/City ______State _____ Zip ______

Email ______Fax # ______

MD 4-H Hall of Fame Award Nominee’s Name:

______

1.Citizenship as exemplified by participation in civic, community, state, regional and national public service related activities evidencing concern for the welfare of others, especially as they relate to 4-H.

2. Leadership as exemplified by qualities of leadership and acceptance of leadership responsibilities in civic, community, professional and business related activities that directly or indirectly benefit

4-H.

3.Career Accomplishments as exemplified by accomplishments and success in his/her chosen career and as a mentor or role model.

MD 4-H Hall of Fame Award Nominee’s Name:

______

4.Character as exemplified by evidence of the influence of 4-H involvement (if a 4-H alumni or volunteer) in the nominee's life and/or his or her commitment to 4-H.

5. Any other information that would be beneficial for the selection committee to know.

Form Updated: 2012 Maryland Volunteer’s Association Awards Committee- Approved by Dr. Lisa Dennis

University of Maryland Extension programs are open to all citizens without regard to race, color, gender, disability, religion, age, sexual orientation, marital or parental status, or national origin.