Chickasaw County
4-H County Council Application
Name:_____________________________
Year in School (Fall 2015):_______
Club:_____________________________
Years in 4-H:______
Email:____________________________
Cell Phone: _________________________
Parents:_____________________________________
I understand that it is my responsibility to serve as a positive role model for younger 4-H
members. I will be expected to attend the Region 4 County Council Retreat on August 30th and
attend monthly meetings on a regular basis.
4-H Projects I am enrolled in:
What I like best about 4-H:
What I have learned in 4-H:
Please share specific examples of how you plan to contribute leadership, citizenship and communication
skills through the 2015-2016 County 4-H Council
Leadership:
Citizenship:
Communication:
What are your ideas for improving or growing our County 4-H program?
Signature:_______________________ Date:_______________