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APPLICATION FORM FOR NATIONAL 4-H TRAVEL OPPORTUNITIES

 

INSTRUCTIONS:
    This application form is to be completed by the 4-H member.  Please complete in full and return to: NB Council 4-H Office

     267 Connell Street, Unit 5

     Woodstock, NB
     E7M 1L2

The application must be received no later than 4:30pm on November 30th , 2002.

GENERAL INFORMATION:

NAME: ____________________

TELEPONE NUMBER: (   )___-____

ADDRESS:_______________________________

POSTAL CODE: ____ - ____

DATE OF BIRTH: ___/___/___ AGE: ____
                     (MN/DY/YR)

SCHOOL: ____________________  

GRADE COMPLETED: ____  YEAR: _____

PARENT(S)/GUARDIAN(S): __________  __________

OCCUPATIONS:  _____________    ______________

PREFERRED AIRPORTS:
1. _______________
2. _______________

DO YOU SMOKE? YES ___ NO ___

LANGUAGES:
ENGLISH ____
FRENCH ____
BILINGUAL ____

TRAVEL OPPORTUNITIES: Rank 1- 5 in order of preference.

NATIONAL CAREERS CONFERENCE
(Winnipeg) ____

NATIONAL CONFERENCE
(Washington)   ____

NATIONAL CITIZENSHIP CONFERENCE
 (Ottawa) ____

NATIONAL CONFERENCE
(Toronto)    ____

INTERPROVINCIAL EXCHANGE
  ____

List five provinces in order of preference.
(Only 1 delegate from each provincegets to go on the exchange.)
(PEI, Quebec, NS, BC, Ontario)

1. _____________________

2. _____________________

3. _____________________

4. _____________________

5. _____________________

DATE: __________________
SIGNATURE: _________________

PLEASE USE SEPARATE SHEETS OF PAPER TO ANSWER THE FOLLOWING:

PROJECT/ACHIEVEMENT:

    1. List years of achievement and projects achieved in.

PARTICIPATION IN 4-H ACTIVITIES:

    1.a) List Club 4-H activities you have participated in and the year. (Public Speaking, tours, etc.)

    b) List awards received within your Club and the year.

    2.a) List District 4-H activities you have participated in and the year.   For example: (4-H Camp, Rallies, Tours, Public Speaking, Contests, etc.)

    b) List District awards received and the year in which they were achieved.

    3.a) List Provincial 4-H activities you have participated in and the year.  For example: ( Provincial 4-H Conference, Public Speaking, Provincial 4-H Shows, etc.)

    b) List Provincial awards received and the year in which they were received.

    4. List other activities you have participated in and the year.  Some examples are MWF, AWF,  EBI Showcase, Scotiabank Hays Classic, Knobhill Beef Heifer Classic, etc.)

 

LEADERSHIP ROLES:

    1.a) List Club offices held and the year. (President, Treasurer, Club Reporter, etc.)

    b) List the Junior Leadership projects you have completed and the year.

    c) List District offices held and the year.

    d) List special club or District 4-H responsibilities you have carried out.

 

GENERAL INFORMATION:

    1.   Which aspect of 4-H has been most beneficial to you?

    Give reasons for your answer.

    2. What would you like to see changed in 4-H? Why? How?

    3. Comment on your participation in 4-H, especially your responsibilities as an officer, junior leader, etc.

    4. What do you see as your future role in 4-H?

    5. What are your hobbies, special interests, skills, etc? (Sports, music, drama, writing, drawing, painting, debating, etc.)  How have you participated in the above?

    6. What are your career plans?  Give reasons for your decisions.

 

Thank you for filling out this application.  Good luck with your choices!  You will get the results in early January 2003.

LEADERS EVALUATION OF MEMBER

Please give your appreciation of this member's overall 4-H record in answering the following questions.  Please be as complete as possible.  In the second part, please score the member out of 50 based on your overall impression of his/her years in 4-H.  Use additional sheets if needed.  Return evaluation to: NB 4-H Council Office

              267 Connell Street, Unit 5

              Woodstock, NB

              E7M 1L2

Must be received no later than 4:30pm on November 30th, 2002.  Leaders may send evaluation separate from the member's application. 

 

1. Describe the member's effort and initiative over the years in 4-H.  Is the member eager to help?

 

2. What leadership ability has the member shown?  Has he/she followed through with what he/she starts?

 

3. Does the member take an interest in his/her work?  Is he/she willing to try new things and complete all exercises?

 

4. Is the member co-operative?  Please explain.

 

5. How has his/her attendance been?  Are they active, or only there in mind?

 

6. How do you think the member would do on a Travel Opportunity?

 

7. Final Comments:

 

DATE: ________________ MEMBER'S SCORE: _______________

LEADER'S SIGNATURE: _______________________