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National Members Application

2007 APPLICATION FORM FOR NATIONAL 4-H TRAVEL OPPORTUNITIES – 4-H MEMBERS

INSTRUCTIONS:      This application form is to be completed by the 4-H member.  Please complete in full and return to the following address by December 15, 2006:

NB 4-H Council Office

  267 Connell Street, Unit 5

 Woodstock, NB

E7M 1L2

GENERAL INFORMATION:

NAME: ____________________ TELEPONE #: (   ) ___- _____

ADDRESS:______________________________________________

POSTAL CODE: ____ - ____E-mail:_________________________

DATE OF BIRTH: ___/___/___ AGE: ____________(MM/DD/YY)

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- 6 in order of preference.

NATIONAL 4-H CONFERENCE (Washington, D.C., March 22-29)   _____

NATIONAL 4-H CITIZENSHIP SEMINAR (Ottawa, April 13-19)  _____

ROYAL BANK 4-H INTERPROVINCIAL EXCHANGE (July 4-15) _____

You host your exchange partner from August 8-19.  List five provinces in order of preference. (Ontario, Manitoba, Saskatchewan, Alberta, BC)   

1. _____________________

2. _____________________

3. _____________________

4. _____________________

5. _____________________

NATIONAL 4-H MEMBERS CONFERENCE

(Toronto, October 31-November 4)       _____

NATIONAL 4-H SKILLS AND THRILLS CONFERENCE

(Winnipeg, November 22-25)        _____  

W. GARFIELD WESTON FOUNDATION 4-H U.K. EXCHANGE

(To U.K. June 7-July 15 – UK to Canada September 29 –November 4) ____

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.

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 EBI Showcase, Scotiabank Classic, Scotiabank Beef Heifer Classic, Junior Sheep Show at the RAWF, Madison Dairy Conference, Agribition, 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 .

4-H Members must be 16 years of age as of the date of the conference or seminar and have been in the 4-H Program for at least two years.  There is a fee of $ 250.00 per delegate which includes $ 232.00 registration fee and $ 18.00 cancellation fee.

Thank you for filling out this application.  Good luck with your choices! 

4-H 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 Road, Unit 5

        Woodstock, NB

         E7M 1L2

You 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: __________________________

National Leaders Application

2007 VOLUNTEER 4-H LEADER APPLICATION FORM NATIONAL TRAVEL OPPORTUNITIES INSTRUCTIONS:      Listed below are the 2007 National 4-H Travel Opportunities available to all Screened Volunteer 4-H Leaders.  Please complete both sides of the following application form and return it to the following address by December 15, 2006:     NB 4-H Council Office     267 Connell Street, Unit 5     Woodstock, NB     E7M 1L2 DELEGATE PROFILE: NAME: ____________________ CLUB: ______________________ TELEPHONE NUMBER: HOME (___)___-_____ WORK (___)___-_____ ADDRESS: ________________________________________________ POSTAL CODE: ____-____ E-mail:  ___________________________ PRESENT OCCUPATION: ____________________________________ NUMBER OF YEARS AS A VOLUNTEER 4-H LEADER: _____________ PREFERRED AIRPORTS: 1. _______________ 2. ________________ DO YOU SMOKE? YES ____ NO ____ LANGUAGES: ENGLISH ______ FRENCH ______ BILINGUAL _______ ATTENDED/CHAPERONED ANY 4-H CONFERENCES? YES ___ NO ___ IF YES, PLEASE STATE WHICH ONE: _________________________ TRAVEL OPPORTUNITIES: Please rank in order of preference. CHAPERONE NATIONAL 4-H CITIZENSHIP SEMINAR (Ottawa, April 13-19, 2007) (If needed)      ______ NATIONAL 4-H VOLUNTEER LEADERS CONFERENCE (Toronto, October 31 – November 4, 2007) (Can send 5 leaders)   ______ CHAPERONE NATIONAL 4-H MEMBER'S CONFERENCE (Toronto, October 31 – November 4, 2007) (If needed)    ______ CHAPERONE CANADIAN YOUNG SPEAKERS FOR AGRICULTURE              (Toronto, Ontario, November 2007) (If needed)     ______ *PLEASE ANSWER THE FOLLOWING QUESTIONS USING ADDITIONAL SHEETS OF PAPER FOR QUESTIONS 5 – 9. BACKGROUND INFORMATION: 1. WHAT IS YOUR AGE? ______ Under 20 ______ 31 – 40 ______ 51 – 60 ______ 21 – 30 ______ 41 – 50  ______ Over 60 2. WHAT IS THE APPROXIMATE NUMBER OF MEMBERS IN EACH AGE GROUP THAT YOU DEAL WITH REGULARLY? ______ Under 10 ______ 10 – 12 ______ 13 – 16 ______ 17 – 19 ______ Over 19 3. DO YOU OR HAVE YOU HAD 4-H AGED CHILDREN? _______ YES  ______ NO   IF YES, WERE THEY INVOLVED?  ______ YES ______NO 4.     WERE YOU EVER A 4-H MEMBER? ______ YES ______ NO   IF YES, HOW MANY YEARS? _______________________ ANSWER THE FOLLOWING ON SEPARATE PAPER: 5.     IN WHAT AREAS OF 4-H LEADERSHIP HAVE YOU BEEN                                              INVOLVED? (GENERAL OR OVERALL)  PROJECT LEADERSHIP AREAS? 6.     WHAT 4-H ACTIVITIES HAVE YOU PARTICIPATED IN AS A                 4-H LEADER/MEMBER? (AT ANY LEVEL) 7.     WHAT SPECIAL 4-H RESPONSIBILITIES HAVE YOU ACCEPTED      BEYOND THE CLUB LEVEL? 8.     WHAT ARE SOME SPECIAL ACTIVITIES OR HOBBIES YOU                       ENJOY OR ORGANIZATIONS IN WHICH YOU ARE INVOLVED? 9.     COMMENTS? (TIME CONSTRAINTS, ETC.)