What IS National 4-H Conference?
What Is the Cost?
National 4-H Conference is a working conference.
Delegates attend workshops and discuss issues in
round table discussion groups to suggest future
programming for 4-H on a national, state, and local
basis. Delegates share their action plans with federal
stakeholders and meet with federal legislators on
Capitol Hill to discuss the impact of 4-H and
Extension programming in their areas.
State 4-H Office& Illinois 4-H Foundation cover
costs for:
 Conference Registration & Room (approx. $800,
includes most meals)
 Air travel costs from Illinois to Washington,
D.C. (Approx. $350)
 One evening’s dinner
Sightseeing is limited during the actual
conference. Currently, the conference is scheduled to
begin Saturday evening, March 24 and end the
evening of March 28. We will be staying one extra
day for sightseeing and return on Friday, March 30.
Once the delegation returns home, they are
expected to report to the State 4-H Staff and Youth
Leadership Team on the conference AND commit to
one year of work on a special project. This project
may be a carry-over project from previous years or
may be a new project of the delegates’ design.
Who Can Attend?
The Illinois delegation will consist of 5-6 teens, ages
15-18. Delegates must be 15 by January 1, 2012 and
cannot be 19 by the trip. (First consideration goes to
State 4-H Youth Leadership Team; Team members
may be 19-20.) Teen delegates should represent the
diversity of Illinois teen 4-H members in ethnic
origin, age, residence, and type of 4-H experience
(traditional club, special interest, individual member,
EFNEP, etc.). Regional representation will also be
considered. At least one adult chaperone will
accompany the group to Washington.
Important Deadlines
November 14 - YLT applications due
December 12 – “Member at large” applications due
January 4, 2012 - $350 participant fee due
January 13, 2012 – Last day to cancel and receive
participant fee refund
Delegates pay:
 $350 participant fee*
 Ground transportation in Illinois & Washington,
D.C. (approximately $50-75)
 6 meals
 Expenses for sightseeing**
 Own incidentals
* If this amount poses a financial difficulty,
alternative funding may be available. Interested
youth or local Extension staff should contact the
State 4-H Office regarding concerns. If a delegate
cancels after January 13, the $350 participant fee
will NOT be refunded. After a delegate has
completed the obligations of the National 4-H
Conference trip, $150 will be returned to the
delegate.
** This amount will include ground transportation
and may include any special entry fees.
Trip Information
Two pre-conference orientations
will be held for Illinois delegates.
These orientations will be held
via Meeting Place, the
University of Illinois teleconferencing network, at no cost
to the delegates. Delegates are
expected to attend the preconferences, as well as any
post-conference sessions to
discuss and carry-out the
group’s state plan.
2012 National 4-H Conference
Statement of Interest
Illinois Delegates
I am interested in attending National 4-H Conference, March 24-30, 2012. I realize that these dates include the
conference and one extra day for sightseeing and the additional expenses will be at my cost. I understand that if I
am selected and accept this trip, I will be expected to pay a $350 participant fee, plus my ground travel in Illinois
and Washington, D.C. and 6 meals during the week. The $350 is non-refundable should I cancel after January 13,
2012. I also agree to serve a one-year commitment to the delegation’s “project” upon our return to Illinois. A
portion of the participant fee ($150) will be returned to me a year after the trip, providing all trip obligations are
met.
PLEASE type or print your information!
Legal Name:
(Name that on your driver’s license – this is submitted for airline tickets and must match your government id)
Street Address:
City/State/Zip:
County:
Telephone:
(
)
Birthdate:
/
/
E-mail:
Name you would like on your Conference Name-tag: _____________________________________
The following information is requested for Conference registration and USDA reporting purposes. (Should you be
selected, I must have this information to register you for this event.)
Are you of Hispanic ethnicity? ____ Yes
____ No
What would you consider your racial group?
White
Asian
Residence:
Shirt Size:
Black
American Indian or Alaskan Native
_____ Native Hawaiian or Pacific Islander
Farm
Town/City, 10-15,000
Central City, over 50,000
_____ S
_____ M
Town, Under 10,000 & open country
Suburbs over 50,000
_____ L
_____ XL
_____XXL
Why do you want to attend National 4-H Conference?
What do you expect to do with the knowledge and/or experience gained from this trip?
(continued on back side of page)
List three words to describe yourself – and indicate why you selected those words:
Please list what you believe to be the four most important leadership positions you have held and indicate why you
selected those positions:
Which words come closest to describing your personality style (Choose ONE):
Fun-loving, party-person, risk-taker
Organized, live by the calendar
Relationship-oriented, enjoy being with friends
Enjoy science, methodical, check out all the alternatives before making decisions
Why should you be selected for this opportunity?
A recommendation from Extension staff member MUST be attached to this application for youth who are not
State 4-H Youth Leadership Team members.
PLEASE ATTACH A PHOTO OF YOURSELF TO THIS APPLICATION if you are not a State
4-H Youth Leadership Team member.
Applications must be received by:
November 14 for Illinois State 4-H Youth Leadership Team members
December 12 for “member-at-large” applicants
Return to:
Debra Stocker
State 4-H Office
801 N. Country Fair Drive, Suite E, Champaign, IL 61820
FAX: 217/333-9287
dstocker@illinois.edu