2016 NATIONAL 4-H CONFERENCE
Recommendation Form for 4-H Staff
To be completed by 4-H Staff recommending the youth applicant
Name of Youth Applicant:
Your Name:
Email Address:
Phone Number:
4-H Position Title:
County:
Please complete the following section by ranking the youth applicant in relation to other youth
that you have worked with of the same age. Please provide specific examples justifying your
ranking. Use additional pages as needed, but please do not use more than one-half page per
answer to each question.
Strongly
Agree
1. The nominated youth demonstrates leadership skills that set them
apart from other teen leaders.
Please provide specific examples:
2. The nominated youth has excellent communication skills, especially
speaking/presentation skills.
Please provide specific examples:
Neither
Agree
Agree nor
Disagree
Disagree
Strongly
Disagree
3. The nominated youth works well with adults and peers.
Please provide specific examples:
4. The nominated youth would be a positive representative of
Minnesota 4-H at the National 4-H Conference.
Please provide specific examples:
5. Describe the nominee’s involvement in the 4-H program, school & community organizations. Include leadership positions and
activities that were both elected or self-selected. Please describe any youth service activities that they have contributed to and their
involvement.
6. As part of this application process, youth applicants are asked to identify someone who can help them carryout the “Taking it Home”
community action plan that they put together. Do you see yourself as that adult mentor? Or, is there a 4-H volunteer interested in
citizenship in your county? Please indicate name of adult mentor:
THIS COMPLETED FORM SHOULD BE POSTMARKED NO LATER THAN NOVEMBER 16, 2015, AND SENT TO:
Diane Lambrecht
University of Minnesota Extension
4100 220th Street West, Suite 100
Farmington, MN 55024
For information about the National 4-H Conference, visit http://www1.extension.umn.edu/youth/mn4H/events/national-conference
© 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.