PROGRAM INFORMATION FOR MINNESOTA DELEGATION
Citizenship Washington Focus (CWF)
ABOUT CITIZENSHIP WASHINGTON FOCUS 2016
Citizenship Washington Focus (CWF) is a week-long 4-H citizenship program for youth ages 14-19
(see age requirement on website) that takes place at the National 4-H Youth Conference Center.
CWF provides opportunities for participants to:

strengthen their communication, leadership,
and citizenship skills on a national level.

understand the importance of civic and
social responsibilities as they relate to the
development of better citizens and leaders.

exchange ideas, practice respect, and form friendships with other youth from diverse
backgrounds.

experience hands-on learning using the historical backdrop of Washington, D.C.

practice what is learned about engaged citizenship by developing and implementing a Pay
It Forward Agreement CWF: Call to Action plan.
CWF participants also enjoy:

a behind-the-scenes look at our nation's capital and the chance to meet members of
Congress.

motivational speakers, educational workshops, and assemblies that increase individual
commitment to citizen involvement and build lifetime skills for success.

activities that encourage new and lasting friendships.

an enthusiastic staff of young adults that work directly with them.

rigorous schedule consisting of long hours, site seeing, walking many miles and bus rides.
IMPORTANT DATES IN 2016

January 15 - CWF application support form available online.

February 16 - CWF youth delegate application & chaperone application available online.

March 28 - All payments must be postmarked for selected youth participants.

July 2 - Pre-workshop in Farmington beginning at 9:00 a.m. until mid-afternoon. Please
arrive by 8:45 a.m. for registration. Minnesota delegation departure follows workshop.
Please note that this conference begins with the pre-workshop held in Farmington
and ends with the delegation returning from Washington DC via bus transportation.
All youth delegates and chaperones are expected to follow this itinerary. Other
departure dates and travel arrangements will not be accepted.

July 2 - July 8 - Minnesota delegation attendance at CWF.

July 9 (evening) - Minnesota delegation returns to Farmington Regional Office between
7:00-9:00 p.m.
Required Webinars:
Delegates and parents are required to view a pre-recorded webinar scheduled in May followed by
webinar evaluation. Also, a conference call number will be set up in May to allow for additional
questions.
WHO CAN ATTEND
Eligible youth delegate applicants must be currently enrolled in a Minnesota 4-H Program and
must have completed the ninth grade by July 1, 2016 and be at least age 14. If graduated from
high school in the spring of 2016, the applicant must be age 19 or younger through July 9, 2016.
APPLICATION PROCESS
Application materials and more information can be found at:
http://www1.extension.umn.edu/youth/mn4-H/events/citizenship-washington-focus/index.html

Interested applicants should first check with their county 4-H staff to see if additional
county-specific requirements and application processes exist.

Completing the following will be necessary to submit an eligible application. Please note
that all applications must be printed legibly or typewritten. Appropriate signatures must
be completed where noted.
1. A complete 2016 CWF Application Packet, containing:

2016 Youth Delegate Application Form

2016 Pay it Forward Agreement CWF: A Call to Action

2016 Application Support Form (if completed in advance, include only one
copy with signatures in the final packet)
2. A $700 down payment (payable to the University of Minnesota) per participant must
be included. The remaining $700 payment will be due on or before March 28, 2016.
Please see the above-mentioned website for cancellation policies.

Completed applications and deposits must be sent via postal mail and postmarked no
earlier than February 16, 2016, or later than March 28, 2016. Please note that participants
are accepted on a first-come, first-served basis, and spots typically fill quickly.
Applications arriving before or after the dates mentioned above will not be accepted.
COMPLETED APPLICATIONS AND PAYMENTS SHOULD BE SENT TO:
Diane Lambrecht
University of Minnesota Extension
Farmington Regional Office
4100 220th Street West, Suite 100
Farmington, MN 55024
© 2015 Regents of the University of Minnesota. All rights reserved. University of Minnesota Extension is an equal opportunity educator and employer. In
accordance with the Americans with Disabilities Act, this material is available in alternative formats upon request. Direct requests to 612-6242116. Printed on recycled and recyclable paper with at least 10 percent postconsumer waste material.
2016 YOUTH DELEGATE APPLICATION FORM
Citizenship Washington Focus
TO BE COMPLETED BY APPLICANT:
Legal Name:
Completed applications and
payments should be sent to:
Diane Lambrecht
University of Minnesota Extension
Farmington Regional Office
4100 220th Street West, Suite 100
Farmington, MN 55024
Name for Nametag:
Date of Birth:
Male or Female:
Address:
Grade (2015-2016):
City:
Home Phone:
Zip:
Applicant Cell Phone:
Participant E-mail:
County/Program:
Participant T-Shirt Size (Adult S, M, L, XL, 2XL):
Parent/Guardian(s) Name:
Address if different from Applicant:
Parent/Guardian Home Phone:
Parent/Guardian Cell Phone:
US Congressional District (see www.house.gov):
Name of House Representative (see www.house.gov):
On the national Citizenship Washington Focus website, it reminds future delegates that:

CWF is more than just another D.C. field trip – 4-H’ers learn essential civic leadership
skills and leave with the tools that will allow them to bring about real change in their
communities. Please consult the Pay it Forward Agreement and CWF: A Call to Action.
If you were to identify one community issue that needs attention, what would it be?
Share a possible service-learning project that would address this issue and bring about real
change in your community.
I am confident I would know how to plan and organize a service-learning project (circle one):
1
Fully Agree
2
Somewhat Agree
3
Somewhat Disagree
In order to facilitate bus seating for the trip, please answer the following:

Name three to four of your areas of interest:

What types of activities do you enjoy?

Would you consider yourself outgoing? Or more reserved?
4
Disagree
2016 CITIZENSHIP WASHINGTON FOCUS: A CALL TO ACTION
Pay it Forward Agreement
TO BE COMPLETED BY APPLICANT, PARENT/LEGAL GUARDIAN AND MENTOR
**If this form was completed in advance, please replace this copy of the form with the signed copy and include it
with payment and the application.
As a Citizenship Washington Focus delegate, before, during and after this experience, I will
have the responsibility to:

Learn about the democratic process and my role as a citizen.

Learn ways to strengthen my communication, leadership, and other citizenship skills.

Share ideas, respect, and friendship with youth from my community and other youth from
all over the country.

Be respectful to the people, places, and property around me at all times.

Act in a way that is consistent with being a role model and a representative of my
community, club and Minnesota 4-H at all times during this experience.

Learn about and implement the CWF: A Call to Action guide (found on CWF website).
As a Citizenship Washington Focus delegate, I will have the responsibility to prepare before
the conference, engage during the conference and to commit to the “Pay It Forward CWF: A
Call to Action” community action plan following the experience. I will have the responsibility
to complete each of the following:
Promoting 4-H to 4-H or larger community

Design and deliver a presentation to share your conference experience to a 4-H
audience and/or a funding partner. Share what you did, what you learned, and how
this experience has changed your ideas on citizenship.
Service to the Greater Community

Coming home and using what you learned by designing and implementing as an
individual or group, a “CWF: A Call to Action” community action plan that will
provide service to the community. See CWF: A Call to Action guide on website.
Complete an evaluation of experience in December 2016.
Who will be your adult mentor to help you carry out “Pay It Forward, CWF: A Call to Action”
(Please see CWF: A Call to Action Adult Mentor Job Description found for details. Found on 4-H events CWF website).
Name of Adult Who Could Mentor Me:
Relationship to Me:
Applicant Signature:
Date:
Parent/Legal Guardian Signature:
Date:
Revised December 9, 2016
2016 APPLICATION SUPPORT FORM
Citizenship Washington Focus (CWF)
**If this form was completed in advance, please replace this copy of the form with the signed copy and include it
with payment and the application.
TO BE COMPLETED BY PARENT/LEGAL GUARDIAN:
Name of Youth Delegate Applicant:
Address:
City:
Zip:
E-mail Address of Youth Delegate Applicant:
Name(s) of Parent(s) or Legal Guardian(s):
Address:
City:
Parent/Guardian Home Phone:
Zip:
Cell Phone:
E-mail Address:
Payment in the amount of $
is attached (make check payable to the University of
Minnesota). I have read and understand the refund policy.
Printed Name of Parent/Legal Guardian:
Signature of Parent/Legal Guardian:
Date:
TO BE COMPLETED BY YOUTH DELEGATE APPLICANT:
Printed Name of Youth Delegate Applicant:
Signature of Youth Delegate Applicant:
Date:
TO BE COMPLETED BY COUNTY 4-H PROGRAM COORDINATOR OR EXTENSION EDUCATOR:
I acknowledge that the above participant can attend Citizenship Washington Focus (July 2-July 9,
2016, includes travel dates). Also, the 4-H Federation or Leader’s Council agrees to pay $
(make check payable to the University of Minnesota) of the cost for this participant, which will be
paid and postmarked to the above address on or before March 28, 2016.
4-H Program Coordinator or Extension Educator Name:
Signature:
Date:
REFUND POLICY:
Please see information on the CWF Refund Policy found on the CWF website at:
http://www1.extension.umn.edu/youth/mn4-H/events/citizenship-washington-focus/index.html.