Bring Nomination to the
January 4-H Council Meeting
Leadership Award Nomination Form
Naomi Crouch Leadership Award (Business)
Frank Graham Leadership Award
Naomi Crouch Leadership Award (Individual)
Individuals may be nominated for both awards
Check box(es) which apply
Nominee’s Name
Nominee’s Address
Street
Nominees Day Phone (
City
)
State
Evening Phone (
County
Zip
)
Region
Was the nominee a 4-H member?
Yes
No
If yes, where?
Relationship to 4-H
Number of years of service or support to 4-H:
Describe significant contributions to 4-H:
What is the scope of the contribution? Include any information you consider pertinent such as: length
of commitment, impact on 4-H, impact on their life, impact on the community/program/county/state/etc.,
was there growth in the program or changes that occurred.
Community roles other than 4-H:
List significant 4-H activities:
Nominated by:
Council, club, or other:
County:
4-H Youth Specialist or YEA:
Address:
Street
Telephone Number (
City
)
Evening Phone (
State
Zip
)
Use the back of this sheet if necessary. Please attach supporting documents to this form.