Key Award Application Due March15. Be sure to complete all 6 pages. Criteria: Must be 16 years of age or older and currently enrolled in 4-H
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1 Key Award Application Due March15 Be sure to complete all 6 pages Criteria: Must be 16 years of age or older and currently enrolled in 4-H A. EVALUATION OF MY 4-H PROGRAM To get a good perspective of all items requested read application before completing Name of 4-H Member: Mailing Address: City, State and Zip: Address: Phone Number: Cell Phone: Parent / Guardian: Date of Birth: Your Age (as of January 1): 4-H Club: # of Years in 4-H: Have you received any of the following awards (check all that apply): Achievement Award Citizenship Award Leadership Award Have you been a summer camp counselor? Yes No Engaged as a Junior Leader in the County: Yes No Number of record books completed and reviewed: 1 P a g e - K e y A w a r d A p p l i c a t i o n d o n o t a d d a d d i t i o n a l p a g e s
2 PROJECT LISTING List projects currently enrolled in and past projects. Indicate year in project and if you are/were a Youth Leader. DO NOT EXCEED SPACE ALLOWED; be selective if necessary 1 Project Name Currently Enrolled # of Years in Project Youth Leader Achievements P a g e - K e y A w a r d A p p l i c a t i o n d o n o t a d d a d d i t i o n a l p a g e s
3 B. LIST OFFICER & COMMITTEE LEADERSHIP POSITIONS FOR ALL 4-H ACTIVITIES/EVENTS Describe leadership role and experience you have had on the club, county, district, or state level Leadership Club County District State Years Role 4-H Leaders Federation X C. COMMUNITY SERVICE PROJECTS CLUB LEVEL Year Committee Served on Year Service Project Roadside Pick Up Visiting nursing homes throughout the year and handing out gifts 3 P a g e - K e y A w a r d A p p l i c a t i o n d o n o t a d d a d d i t i o n a l p a g e s
4 D. CLUB and COUNTY LEVEL ACTIVITIES Year 2015 Other 4-H Activity Participation Delegate / Trips Awarded / Drama / Music / Athletics / Safety / Other Attended 4-H camp as a counselor, participated in drama and music festival, went on 4-H exchange trip to Delaware E. NON 4-H ACTIVITIES (include church, school, other organizations, and/or sports activities) Leadership Role Role in This Activity Year(s) Tutored 2 nd grades in reading and 2016 present (tutor) School tutor and church choir was a junior choir member 2015 present (choir) 4 P a g e - K e y A w a r d A p p l i c a t i o n d o n o t a d d a d d i t i o n a l p a g e s
5 F. PLEASE ANSWER THE FOLLOWING QUESTIONS AS COMPLETELY AS POSSIBLE 1. What 4-H experience has been most enjoyable to you and why? 2. What skills/knowledge have you gained or experienced as a 4-H member? How are they being used? 3. Please give examples of how you interact & work with youth within your club, community, or 4-H program. 4. Why should you be considered for this award? What does it mean to you? 5. How has 4-H challenged and changed you? 5 P a g e - K e y A w a r d A p p l i c a t i o n d o n o t a d d a d d i t i o n a l p a g e s
6 G. RECOMMENDATION FORM The information that I have stated in this application is true and should be considered in the awards application process. Signature of Member Date I support my child s application for the Key Award that he/she is applying for. Signature of Parent/Guardian Date Recommendation of Club Organizational Leader: Please state how this member has been involved in your club and if they should be considered for this opportunity. If Club Organizational Leader is a parent, PLEASE identify another leader in the club or a project area that could complete the recommendation on their behalf. Is this member in good standing in your club? Yes No Signature of Club Organizational Leader Date 6 P a g e - K e y A w a r d A p p l i c a t i o n d o n o t a d d a d d i t i o n a l p a g e s
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POWAY UNIFIED SCHOOL DISTRICT EXTENDED STUDENT SERVICES (ESS) PROGRAM ALTERNATIVE PROGRAMS PARENT CONTRACT PLEASE PRINT LEGIBLY IN INK PRESS HARD SCHOOL NAME STARTING DATE IN ESS PARENT/GUARDIAN LAST NAME