4-H Adult Volunteer
National Dairy Conference
Application Form
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Return to:
4-H Volunteer Opportunities
Extension 4-H Youth Bldg
Iowa State University
Ames IA 50011-3630
This completed application can be considered for one or more of the 4-H volunteer opportunity listed below.
Applications are due one to three months prior to the event.
Check the event(s) you are making application for, noting earliest event date.
Applications will be kept on file for one year after being received.
Secure additional information for each event from the county Extension office.
National Dairy Conference (in October) – Due July 1
Personal Information
Name
County
Date of Birth
Spouse’s Name (if applicable)
Address
Phone Numbers: home
Present
Occupation
Title (if
applicable)
work
E-mail
Social Security Number
4-H Information (by years)
Member
County Extension Council
Volunteer Group Leader
Paraprofessional
County 4-H Committee
Professional
Fair Committee/Board
Other (specify)
Continue to pages 2 & 3
Iowa State University Extension programs are available to all without regard to race, color, age, religion, national origin, sexual orientation,
gender identity, genetic information, sex, marital status, disability, or status as a U.S. veteran. Inquiries can be directed to the Director of
Equal Opportunity and Compliance, 3280 Beardshear Hall, (515) 294-7612.
Issued in furtherance of Cooperative Extension work, Acts of May 8 and June 30, 1914, in cooperation with the U.S. Department of
Agriculture. Cathann A. Kress, director, Cooperative Extension Service, Iowa State University of Science and Technology, Ames, Iowa.
November 2014, State - 52
Complete the following questions, giving specific consideration to the criteria for the event(s) checked
above.
1.
Why would you like to represent Iowa 4-H at this event (checked above)?
2.
Describe your current and previous volunteer role(s) on the county/area/state levels in 4-H.
3.
Highlight leadership experiences and responsibilities outside 4-H.
4.
Explain why you would like to attend this event. Include what you feel you can contribute to the
program.
November 2014, State - 53
5.
Explain how and with whom you would share the information and experiences from this event.
6.
In your opinion, what do you think is the most valuable contribution 4-H makes to young people and
adult volunteers?
Signature of Applicant
Date
For County Extension Office Use
In the space below, comment on the role of the above individual as a volunteer in your county 4-H
program. Explain how you view involving this volunteer on the county/area/state level upon return from
the event(s) checked by the applicant.
Signature of Staff Member
November 2014, State - 54