GREENE COUNTY RR 3, Box 129C, Carrollton, Illinois 62016 Telephone: 217/942-6996 Fax: 217/942-3827 Web site: http://www.extension.uiuc.edu/greene/ 4-H Leader Of The Year Nomination Form Greene County 4-H will be presenting a special award each year beginning with the 1997 4-H Achievement or the 4-H Leader of the Year. Nominations may be made by 4-H members, parents, or 4-H alumni. All applications must be signed at the bottom by the person(s) making the nomination and are to be returned to the Greene County Extension Office no later than August 31, 2006 at 4:30 p.m. Name of Nominee _____________________________________________________ Name of Club _________________________________________________________ Tell why you think this leader should be named 4-H Leader of the Year. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ You may use the back of this form or add additional pages if needed. Name of person submitting the nomination ______________________ University of Illinois at Urbana-Champaign College of Agricultural, Consumer and Environmental Sciences United States Department of Agriculture Local Extension Councils Cooperating University of Illinois Extension provides equal opportunities in programs and employment.