State 4-H & Youth Conference, Leadership Washington Focus,

and AmbassadorApplication

County______Date Submitted______20______

Name______Male or Female______

Your age on January 1 this year______Date of Birth_____/_____/_____

Current Grade Level______Phone (____) ______

Address______

______

Name of Parent or Guardian______

Club______Year in 4-H _____ (including this year)

Number of Members in Club______Number of Leaders in Club______

Have you worked in the 4-H Foodstand at County Fair? YESNO

If no, please share your reason: ______

Project Listing

List your most recent projects in which you have been enrolled and indicate years and if presently enrolled. Do not exceed space allowed.

Project / Number of Years Enrolled / Check if enrolled this year
1.
2.
3.
4.
5.
6.
7.
8.

1. What do you hope to learn at the State 4-H & Youth Conference and/or Leadership Washington Focus Trip?

  • Why do you want to go?
  • When you get home, how will you share what you learned?

1a. If you are applying to be an ambassador, why do you think you should be an ambassador?

2a. Describe one of your Leadership Roles in 4-H. (for example: club officer, project youth leader, club committee, etc.)

  • What did you learn while in this leadership role?
  • If youtaught others, please describe what you did?
  • What are your future leadership goals?

2b. List your other 4-H activities.

YearActivity

2c. List your non 4-H activities. (for example: church, school, other youth groups)

YearActivity

3. Describe one 4-H projectthat you feel was the most valuable to you.

4-H Project: ______

  • Describe what you did.
  • What did you learn?
  • What was one goal you set for yourself in this project?
  • Did you accomplish your goal? Please explain.
  • Explain how this 4-H project was valuable to you.

4. Describe one 4-H activity that you participated in or helped your club with that you feel was the most valuable to you or your club.

4-H Activity: ______

  • Describe what you did.
  • What did you learn?
  • Did you accomplish what you planned to?Please explain:
  • Explain how this 4-H activity was valuable to you and/or your club.

5. Pick one community service project you have helped with while in 4-H.

Community Service: ______

  • Explain why you feel it was an important event.
  • Who benefitted from this community service project?
  • What did you learn?
  • What was your role in helping with this community service project?

6. Based on what you have done or learned in 4-H, what is the most important problem or concern 4-H has helped you deal with in a positive way? Why?

Form updatedSeptember 2014

N:\UWExtension\Annette\4-H\FORMS\Trip Application (short form) updated 2012.doc

Please be concise. Do not add pages.

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