Youth Advisory Committee Form

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone *

Email *

Date of Birth *

How many years have you been a 4-H participant? *

If you are no longer a current participant, please tell us where and when you were a member and your reason for not renewing your membership. *

Please list the names the 4-H clubs or projects you have completed. *

Please list the 4-H leadership roles you have held (please include the years and length you held these roles). *

Please list the 4-H provincial activities and events that you have attended, organized or participated in, and the year you participated. *

Please list any 4-H awards you have received. *

Please list any school, community or volunteer activities that you have participated in over the last three years outside of 4-H. *

Please list any hobbies, special interests or skills that you may have. *

Please describe how your skills and experience make you the ideal candidate for this position. *

Please share with us why you want to be part of the Youth Advisory Committee. *

Name of Reference *

First

Last

Relationship to Applicant *

Email *

Phone *

To ensure the above information is true to the best of your knowledge, please sign below *

Date *