Clinton County 4-H Youth Council Application
Due September 1, 2015
Name: __________________________________________________________________________________________________________
Age/Grade in School: _________________________________________________________________________________________
4-H Club Name: _______________________________________________________________________________________________
Number of Years in 4-H: ______________________________________________________________________________________
List years of involvement in 4-H County Youth Council:___________________________________________________
Offices held in 4-H County Youth Council:___________________________________________________________________
T-Shirt Size:________ May we contact you via TEXT on your cell phone?
Yes
or
No
Cell Phone Number: _________________________________ Email Address:_______________________________________
The Clinton County 4-H Youth Council requests a one page (minimum), typed proposal (double
spaced, 12pt. Times New Roman font) addressing:
1. Why you want to be a member of the Clinton County 4-H Youth Council
2. In your own words, please explain what you think is the purpose of the Clinton County 4-H
Youth Council and how you can make a difference.
3. What ideas do you have for the Clinton County 4-H Youth Council?
4. If you were a member last year, what do you think the council may improve on and what do
you think was done well?
Name of Reference:____________________________________________ Phone Number: ____________________________
Please include this cover form along with your written proposal.
Applications may be mailed to Brianne Johnson at the Clinton County Extension Office or emailed to
briannej@iastate.edu.
*You will be notified by the Advisor or a member of the County Council by September 4, regarding
approval of membership.