2016-17 4-H COUNTY COUNCIL APPLICATION FORM
Please complete and return to the Extension Office on or before June 24, 2016
Name: _______________________________________________________
(Please attach photo)
Club: _______________________________________________________________Age: ____________
Address: ___________________________________Town_____________________ZIP_____________
Phone: ___________________________________________ Cell Phone__________________________
E-Mail Address________________________________________________________________________
School___________________________________________________ Grade Completed: ____________
Parents/Guardians: _____________________________________________________________________
Please indicate polo shirt size: S M L XL XXL
1. What leadership experiences have you had in 4-H? Offices held? Committees? Other?
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2. Describe your speaking experiences: Community, 4-H Presentations, Other _____________________
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3. List 4-H project areas you have been involved in: ___________________________________________
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4. List 4-H events and activities you have participated in: ______________________________________
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5. Explain why you have chosen to continue being a 4-H member: (What has 4-H done for you?)
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(please complete other side)
6. What can you contribute to the County Council? (work well with others, good communication skills,
willing to voice an opinion, will help plan and carry out a job, good with younger members, etc.)
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7. Being a County Council member involves a commitment of time. Explain how County Council will fit
into your schedule._____________________________________________________________________
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8. How would you increase 4-H membership in Clayton County? _________________________________
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9. What can you contribute to making 4-H fun and educational for the youth in Clayton County?
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10. List school, church and community involvement:__________________________________________
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11. List any other information you wish to share with this application: (Hobbies & interests)
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12. What are three words that describe you? ________________________________________________
Please attach a photograph of yourself to this application.
Please indicate a time(s) that would best work for your interview on July 7. A letter will be sent confirming your
interview time.
___6:30 pm ___6:45 pm ___7:00 pm ___7:15 pm ___7:30 pm ___7:45 pm
___8:00 pm ___8:15 pm ___8:30 pm ___8:45 pm ___9:00 pm ___9:15 pm
___anytime