Scott Van Kampen and Don McCutcheon Memorial Award

Applicant Information

Name *

First

Last

Age *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone *

Email *

Name of University or College *

Course of Study *

Please list your program name

Year of Study *

Type of Post-Secondary Study *

Degree
Diploma

Applicant Questionnaire

1. Please describe your involvement in the community and at school. How has this helped you develop as a leader? *

2. Describe your educational background. What is the main emphasis of your course of study and your reason for enrolment in the program? *

3. List and describe your farm experience, agricultural employment, or involvement in agriculture. *

4. Explain in your own words what 4-H, JF, or other agricultural youth groups have done for you in terms of personal development, leadership, education, and career choices. *

5. Future goals: Career, involvement, etc. *

6. Other: Please explain any other interests that you may have. Include activities, group awards, other community organizations, etc. *

7. Please attach current resume.

Click or drag a file to this area to upload.

References

Please list two references and their contact information below.

Name *

First

Last

Phone *

Email *

Name *

First

Last

Phone *

Email *