WASHINGTON COUNTY 4-H
Nomination for:
Washington Co. Partner in 4-H Award
Nomination deadline:
October 1st by 4:30 p.m. to the Washington Co. Extension
Office. No late entries accepted.
Award Description:
This industry, business or community organization or person representing the same
provides significant financial or in-kind support to Washington County 4-H programming.
This commitment extends 4-H programming efforts to support a county-wide effort.
Nominee: __________________________________________________________________________
Address: ___________________________________________________________________________
City: __________________________________
State: ________
Zip:__________________
Phone: ________________________________
What contributions has this industry/business/organization made to the 4-H
program and why do you feel they should be recognized?
Nominator’s Signature: ____________________________ Phone: _______________________
Mailing Address: _______________________________ Email:____________________________
Name Printed: _____________________________________ Date: _________________________
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on
the basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation,
and marital or family status. (Not all prohibited bases apply to all programs.) Many materials can be made
available in alternative formats for ADA clients. To file a complaint of discrimination, write USDA, Office of
Civil Rights, Room 326-W, Whitten Building, 14th and Independence Avenue, SW, Washington, DC 202509410 or call 202-720-5964.