National 4-H
Conference
Youth Registration Form
April 9-14, 2016
Washington, DC
State Offices: This form is for gathering information from your attendees. You will need to enter the registration information @ Conference
Registration online.
Contact Information
Please PRINT your name as you would like it to appear on your name badge. (Do not provide nicknames.)
First Name:
Last Name:
Please print your full legal name that matches the photo I.D. you will use to enter secure locations.
First:
Middle:
Male
Last:
Date of Birth:
Female
/
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Age:
Address:
City:
Phone #:
State:
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Home
Work
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Zip Code:
Cell #:
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May the 4-H conference planning team have permission to text the mobile phone listed during
the meeting dates? (Yes or No)
E-mail:
Do you have any special assistance needs?
Yes
If yes, please list:
Do you have any food allergies?
Yes
No
No
If yes, please list:
Emergency Contact Name:
Emergency Contact Phone Number:
Choices
The 2016 Conference t-shirt can be purchased for $13
If you would like to purchase a conference t-shirt please indicate the size you’d like.
T-shirt Size:
Small
Medium
Large
XL
2XL
3XL
National Institute of Food and Agriculture
INVESTING IN SCIENCE | SECURING OUR FUTURE
2016 N4-HC Youth Registration Form
National 4-H
Conference
April 9 -14, 2016
Washington, DC
Roundtable Topics
Rank the top three(1-3) Roundtable Topic Discussions you would most like to participate in:
(Please use the Challenge Question on page 3 to assist with your choices)
You will be involved in one Roundtable Discussion.
_____ Analyzing Climate – NASA (National Aeronautics and Space Agency)
_____ Importance of Agriculture – House/USDA (U.S. House of Representatives
Committee on Agriculture / United States
Department of Agriculture Administration)
_____ Backyard Farming – NIFA (National Institute of Food & Agriculture)
_____ Food Networks – EPA (Environmental Protection Agency)
_____ Bioenergy – DOE (Department of Energy)
_____ Irrigation Options – NRCS (Natural Resources and Conservation Service)
_____ Climate Change – NOAA (National Oceanic and Atmospheric Association)
_____ Disaster Health Impacts – ASPR (Assistant Secretary for Preparedness & Response
at Health & Human Services)
_____ Emotional Safety – SAMHSA (Substance Abuse & Mental Health Services
Administration)
_____ Strengthening Communities – CNCS (Corporation for National and Community
Service)
_____ Fitness – PCFSN (President’s Council on Fitness, Sport & Nutrition)
_____ Plan & Save – DOL (Department of Labor)
_____ College Ready – DOE (Department of Education)
_____ Business Training – SBA (Small Business Administration)
_____ Choosing Peace – State (Department of State)
National Institute of Food and Agriculture
INVESTING IN SCIENCE | SECURING OUR FUTURE
2016 N4-C Youth Registration Form
National 4-H
Conference
National 4-H Conference – 2016 Roundtable Topics
April 9 -14, 2016
Washington, DC
General
Topic
Analyzing Climate
Importance of
Agriculture
Challenge Question
Host
Develop a set of recommendations to get youth involved in taking observations of rainfall, soil moisture, plants,
clouds, and air quality to help NASA understand and monitor climate change and its impact on agriculture across
the United States. How can youth be engaged in analyzing observations to answer environmental questions in their
local community? What resources and support could NASA provide to help youth become leaders in their
communities to communicate the impact of climate change on agriculture and encourage others to submit
observations?
Exploring the importance of agriculture with the House Ag Committee.
NASA (National Aeronautics
and Space Agency)
Backyard Farming
Develop a set of educational tools and resources that could be used with the general public to prepare the backyard
farmer to grow products organically.
Food Networks
How can a network be created to connect edible crops and produce that are not sent to market, to those that are in
need of healthy, wholesome food? What are the edible crops/produce being left? Where are the viable donation
centers (shelters, food banks, faith organizations etc.)?What is the best mechanism to create that network (an app,
community message boards etc.)?
Create an infographic that answers one of the following prompts:
1. How would you define sustainable transportation? How can sustainable bioenergy technologies help meet
sustainable transportation goals?
2. Compare and contrast the environmental impacts of bioenergy and fossil energy, such as greenhouse gas
emissions, water usage, energy balance, soil productivity, biodiversity, etc.
Agriculture is a big consumptive user of water, and as such, can be part of the solution to water shortages. An
alternative is to use another source of water not traditionally used for irrigation. One non-traditional source of water
is the effluent from the Wastewater Treatment Plant. What are the positive aspects about using this treated water to
provide irrigation water? What are the negative issues?
How is your community being affected by climate change? How can you and other young people help make your
community more resilient to climate change? Design a communication product, such as a video, blog, story, social
media campaign, or game, to share your experience with your peers and engage them in making their own
communities more resilient and sustainable.
Identify natural hazards that commonly affect your community and describe the potential impact these hazards have
on your community’s health. Develop unique ways that you might facilitate your local community leaders,
businesses and/or organizations to work effectively together to prevent or minimize these health impacts and
strengthen your community’s ability to prepare.
How can 4-H implement a trauma-informed approach to engage and empower youth and help them share their
adverse life experiences to leverage positive change in the community?
Bioenergy
Irrigation Options
Climate Change
Disaster Health
Impacts
Emotional Safety
Strengthening
Communities
Fitness
Plan & Save
AmeriCorps programs connect people to service opportunities through organizations across the country focused on
strengthening communities and improving lives. We want to make AmeriCorps.gov more appealing and easier for
people to learn how to join AmeriCorps programs. How can we use AmeriCorps.gov to better explain how
AmeriCorps members help lift people out of poverty?
What is the state of inclusion for youth with disability in school/community health and fitness programs? What role
can youth without disabilities play to make sure youth with disabilities will be included in health and fitness
programs or opportunities in their school or community?
Consider how to encourage young adults, ages 16 to 24, who come from low-income rural and urban backgrounds
(may even be new parents themselves) and are earning their first paychecks to learn about financial literacy and
save and plan for their future financial needs. How do we reach this audience? What messages will motivate them
to plan and save?
College Ready
What do teens need to be ready – socially and emotionally – to move away from home and go off to college?
Design resources that teens and their families can use to help them through this transition process.
Business Training
As SBA continues to update its digital tools and resources for millennial entrepreneurs, we would like the student’s
feedback on our millennial webpage and our young entrepreneurs’ e-learning course. Feedback should include any
ideas the students may have for updating current webpages and courses and creating new content.
If you were to serve as adviser to the U.S. Secretary of State, what strategies would you recommend that the
Department of State consider implementing to help ensure that youth in America and abroad become and stay
engaged in peaceful, positive activities and organizations, rather than be enticed to join and participate in groups or
organizations that may have violent or extremist intentions or actions? What experiences or activities in which you
are engaged would work internationally?
Choosing Peace
House/USDA (U.S. House of
Representatives Committee
on Agriculture / United States
Department of Agriculture
Administration)
NIFA (National Institute of
Food & Agriculture)
EPA (Environmental
Protection Agency)
DOE (Dept. of Energy)
NRCS (Natural Resources &
Conservation Service)
NOAA (National Oceanic &
Atmospheric Association)
ASPR (Assistant Secretary
for Preparedness & Response
at Health & Human Services)
SAMHSA (Substance Abuse
& Mental Health Services
Administration)
CNCS (Corporation for
National and Community
Service)
PCFSN (President’s Council
on Fitness, Sport & Nutrition)
DOL (Department of Labor)
ED (Department of
Education)
SBA (Small Business
Association)
State (Department of State)
National Institute of Food and Agriculture
INVESTING IN SCIENCE | SECURING OUR FUTURE
2016 N4-C Youth Registration Form