Kansas Association of Extension 4-H Agents
_______Achievement in Service Award (3-7 years)
_______Distinguished Service Award (Over 7 years)
_______Meritorious Service Award (Over 15 years of service and previous DSA recipient)
_______25 Years of Service
_______Koons Scholarship
______Clover Award
Name:________________________________________________________________________________
Present Position of
Employment and Location_______________________________________________________________
Previous County/District
Agent has Worked and Dates_____________________________________________________________
Please answer the following:
1. Professional Attitude (work and professional associations, Extension committee work and
responsibilities—15 points)
2. Professional improvement (advanced formal education, attendance at National Meeting,
supplemental training, information improvement program—15 points)
3. Professional Accomplishments (size and depth of program, program improvements, program
innovations – 50 points)
4. Personal, Community (personal attitudes and interests, community contributions, interests—15
points)
5. Special Honors (professional honors, community honors—5 points)
6. In a brief summary, tell why this person should be considered for this award.
Due Date: March 1
Return by email to:
Karla Hightower
khightow@ksu.edu
Name:___________________________________________________________
Phonetic Spelling:__________________________________________________
Title:____________________________________________________________
Mailing address:
________________________________________________________________
________________________________________________________________
________________________________________________________________
Telephone Number:________________________________________________
Email address:____________________________________________________
50 word Bio:
Attach a head and shoulders digital photo.
Revised 4/1/15