BE A MEMBER OF THE MINNESOTA 4-H DELEGATION
2016 National 4-H Conference
ABOUT THE NATIONAL 4-H CONFERENCE
The National 4-H Conference is a working conference in which youth and
adults, at the invitation of the US Secretary of Agriculture, assist in the
development of recommendations to help guide 4-H Youth Development
Programs nationally and in their communities. The Minnesota delegation
consists of up to four 4-H youth from across Minnesota.
The purpose of the conference is to:
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engage 4-H youth in personal development experiences that will increase knowledge,
resources, and skills;
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discuss topics affecting youth and 4-H programming nationwide; and

empower and mobilize 4-H youth to create positive social change in their communities in a
meaningful and genuine way.
DATE AND LOCATION
The 2016 National 4-H Conference will be held at the National 4-H Conference Center, located just
outside of Washington, D.C., April 9-14, 2016. For flight transportation purposes, the Minnesota
delegation may depart as early as April 8, 2016, from the Minneapolis/St. Paul airport. They will
return on April 14, 2016.
COST OF EXPERIENCE
Minnesota cost for selected delegate is $990. Nominees are encouraged to seek financial support
for the registration fee from their local 4-H Council/Federation and other local community
organizations. County 4-H Federations/Leaders Councils are encouraged to help defray some of
the cost if their 4-H member is appointed to attend this National Conference. The National 4-H
Conference is supported in part by the Minnesota 4-H Foundation.
QUALIFICATIONS FOR YOUTH APPLICANTS
To be eligible as a Delegate, a youth must:
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Be 15 years old by January 1, 2016 and cannot be older than 19 by June 1, 2016; and must
be at least a sophomore in high school. (Note: Selection preference will be for youth
delegate’s grades sophomore and junior in high school during 2015-2016 school year.)
Have experience and leadership involvement in local, county, regional, and/or state
developmental committees, advisory groups, councils, etc.
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Be concerned about community issues and motivated to design and carry-out action plans
to address identified issues through “Taking it Home” community action plan requirement
(Pre-, During-, and Post-Conference expectations).
Have flexibility to meet changing situations and have growth potential and a curiosity
about situations, people, and events.
Demonstrate strong interpersonal and speaking skills.
Commit to pre-conference expectation: 1) three conference calls; 2) study and reporting
knowledge of Minnesota 4-H program via e-mail; 3) one webinar; 4) study of pre-materials
from National 4-H Conference staff, 5) come to a group consensus on “Taking it Home”
community action plan expectation whether to accomplish individually or as a group.
Complete the application and Paying it Forward “Taking it Home” community action
agreement.
Share your experience with identified stakeholders through a video presentation designed
individually or by all Minnesota youth delegate National 4-H Conference participants.
Be willing to receive the resources necessary to make you successful.
STEPS TO APPLICATION PROCESS
See all registration dates and times that are listed on the website under National 4-H Conference
at: http://www.extension.umn.edu/youth/mn4-h/events/
All applications and recommendation forms must be postmarked no later than November 16,
2015. To apply:
1. Review the background information describing the qualifications of delegates and summary of
expectations prior to applying.
2. Youth must complete the application cover sheet, and the delegate self-recommendation form
from their perspective. Youth must also identify two adults who meet the following
requirements to provide a recommendation on their behalf:

A *non-relative 4-H staff member (program coordinator, club leader, state staff,
etc.) must complete and submit the “Delegate Recommendation Form for 4-H
Staff”.
*4-H Staff must recommend and submit delegate
nomination/recommendation form to Diane Lambrecht/Judith A. Conway
with deadline date postmarked no later than November 16, 2015.
Qualifications for Eligibility are listed above. Please send form directly to
Extension staff identified. Youth applicant should not receive this completed
form.

An *additional adult who is not a 4-H staff member or relative but can be a
teacher, coach, organization adviser, or another adult, must complete and
submit the “Delegate Recommendation Form for a Non-Relative Adult”.
*(Additional Adult) Youth delegate will take responsibility to identify and
deliver adult nomination/recommendation form to adult reference of choice
(other than relative) as noted in recommendation form. Youth delegate will
also follow-up to make sure postmark dates are met. Adult recommendation
on delegate nomination/recommendation form is due to Diane
Lambrecht/Judith A. Conway with deadline date postmarked no later than
© 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.
November 16, 2015. Form is due directly to Extension staff identified.
Youth applicant should not receive this completed form.

(Youth Applicant) Youth nominated will fill out delegate
nomination/recommendation form and answer questions about themselves
from their perspective, including the Paying it Forward “Taking it Home”
Agreement. Nomination/recommendation form is due to Diane
Lambrecht/Judith A. Conway with deadline date postmarked no later than
November 16, 2015. Youth are responsible to make sure that all steps are
completed in the application process. Youth should contact their County 4-H
Program Coordinator to see if there are additional County requirements.
3. A 15-20 minute conference call conference phone or skype interview will be held by the
selection committee with the top 10 applicants. Interviews will take place tentatively during
day of either December 7 or 8. Conference call or skype interview will consist of:
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Interview questions
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One-minute marketing speech on knowledge of the youth development program (with
emphasis placed on telling someone about the 4-H youth development program (with
emphasis on telling someone about the 4-H youth development program that does not
have knowledge of this program.)
One-minute comments on following: identification of a community issue and identifying a
possible community action plan that would address the issue

ALL MATERIALS SHOULD BE SENT TO:
Diane Lambrecht/Judith A. Conway
University of Minnesota Extension
4100 220th Street West, Suite 100
Farmington, MN 55024
Phone: 1-651-480-7703
Email: lambr031@umn.edu
QUESTIONS CAN BE DIRECTED TO:
Judith A. Conway
University of Minnesota, Extension Center for Youth Development
4100 220th St. West, Suite 100
Farmington, MN 55024
Email: conw0076@umn.edu
© 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.
2016 NATIONAL 4-H CONFERENCE
Application Cover Sheet
To be completed by youth applicant:
Full Legal Name:
Preferred First Name:
Date of Birth:
Male or Female:
Grade (2015-2016):
Address:
City:
County:
Regional Office:
Home Phone:
Youth Cell Phone:
Zip:
Email Address:
About your parent/guardian:
Full Name:
Home Address (if different than above):
Home Phone Number:
Cell Phone Number:
Email Address:
About your recommendation form providers:
Name of 4-H staff member submitting recommendation:
Email Address:
Phone:
Name of other adult (non-family) submitting recommendation:
Email Address:
Phone:
Write 1-2 paragraphs on your knowledge of the 4-H Youth Development program.
© 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.
© 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.
2016 NATIONAL 4-H CONFERENCE
Delegate Self-Recommendation Form
To be completed by the youth applicant
Please complete the following section through the perspective of yourself. 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
Agree
Neither
Agree nor
Disagree
Disagree
Strongly
Disagree
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:
© 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.
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 and community organizations. Include
leadership positions and activities that were both elected or self-selected.
THIS COMPLETED FORM SHOULD BE POSTMARKED NO LATER THAN NOVEMBER 16, 2015, AND SENT TO:
Diane Lambrecht/Judith A. Conway
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.
2016 NATIONAL 4-H CONFERENCE “TAKING IT HOME COMMUNITY ACTION PLAN”
Pay it Forward Agreement
TO BE COMPLETED BY APPLICANT AND PARENT/LEGAL GUARDIAN:
As a National 4-H Conference delegate, before, during and after this experience, I will have
the responsibility to:
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Learn about the democratic process and my role as a citizen.
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Learn ways to strengthen my communication, leadership, and other citizenship skills.
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Share ideas, respect, and friendship with youth from my community and other youth from
all over the country.
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Be respectful to the people, places, and property around me at all times.
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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.
As a National 4-H Conference delegate, I will have the responsibility to prepare before the
conference, engage during the conference and to commit to “Taking it Home” community
action plan following the experience. I will have the responsibility to do the following:
Promoting 4-H to 4-H or larger community
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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 “Taking it Home” community action plan that will provide service
to the community.
Who would be a good mentor for you with your Pay It Forward Agreement?
Name of adult who could mentor me:
Relationship to me:
Applicant Signature:
Date:
Parent/Legal Guardian Signature:
Date:
© 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.