WASHINGTON COUNTY 4-H
Nomination for:
Washington Co. 4-H Volunteer of the Year
Nomination deadline:
October 1st by 4:30 p.m. to the Washington Co. Extension
Office. No late entries accepted.
Award Description:
Unselfish and numerous acts of service to 4-H, others, state and/or community are the
major criteria for this award. Service of the most menial to the more important levels, truly
illustrates the giving spirit of heart and hands for this nominee.
Nominee: __________________________________________________________________________
Address: ___________________________________________________________________________
City: __________________________________
State: ________
Zip:__________________
Phone: ________________________________
What contributions has this individual made to the 4-H program and why do you
feel they he/she 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.