Edited July 2015
Leadership Trips & Awards
Application Packet
WI 4-H Youth Conference
Future 4-H Leader Award
Citizenship Washington Focus
National 4-H Conference
National 4-H Congress
State 4-H Key Award
Honor Court
Outstanding 4-H Teen(s) of Racine County
Ambassador Application also included
DUE: To Club Leaders for review NO LATER than September 1st
DUE: To Racine County UW-Extension by September 10th
INTERVIEWS: September 25th & 26th
Awards presented at Recognition Celebration event October 24, 2015
1
Table of Contents
Application Suggestions .............................................................................. 3
Trips & Awards Application Cover Page ........................................... 4
Letter of Recommendation ......................................................................... 5
Application Materials .................................................................................... 6-12
Award Descriptions ........................................................................................ 13-15
Ambassador Application Materials ........................................................ 16-18
The Scoring and Evaluation Process is determined by the 4-H Leader’s Association.
Scoring from Trips & Awards Application
25
25
20
15
5
10
Interview Scores
Leadership
Projects & Activities
Other 4-H
Non 4-H Activities
Neatness of Application
Record Book
10 Personal Appearance, Manner & Maturity
10 Self Expression
10 Leadership
100 Total
30 Total
Total of Points
2
Application Suggestions
4-H awards and trips are based on accomplishments and experiences in 4-H projects and activities, as well
as those in the community. This application will help you present this information to our evaluation panel. The
application allows for a concise statement of what you have accomplished during your total 4-H experience. You
are restricted to the space available in this form. Please note that adding pages will disqualify you!
Section I – 4-H Leadership
In this section, describe leadership experiences you have taken part in; include planning, conducting, and/or
evaluating programs and activities. In this section, try including:





4-H leadership learning or goals that you have set for yourself
Progress towards such leadership goals
4-H Leadership roles and accomplishments that have benefited both you and others in the community.
Membership on committees and elected positions held at the club, county, etc. level
Future goals.
Section II – 4-H Project or Activity Reports
Without repeating specifics mentioned in Section I, select only two of your most important 4-H projects or
activities for the panel to evaluate. One full page is available for each project or activity you choose, so be concise.
Do not add pages, but do consider the following:




Goals for the project or activity
Skills you have learned or developed
Things you have done with this project or activity (demonstrations, meetings, etc)
An application you have exercised from this project or activity to your everyday life
Section III – Other 4-H Activities Summary – (list format)
This section allows you to summarize your participation in various 4-H projects and activities, without
repeating any content from Section I or Section II. In a list format start with your most recent year and be sure to
include any offices or leadership positions, planning committee participation, community service, recreation event,
music, drama, 4-H public relations, demonstrations, speaking or other 4-H events. Say the most with the fewest
words. Indicate to the panel any special responsibilities you may have had, or why a certain activity was especially
important to you. Be thorough, but selective enough to remain in the space provided.
Section IV – Non 4-H Activities Summary – (list format)
Starting with the most recent year, list what you participate in outside of 4-H. Be sure to include any
participation in school, church, and community organizations. This is the only Section on the application in which
non 4-H activities should be discussed.
Section V – Discussion Question
This section allows you to share your thoughts on a question for which there is no correct or incorrect
answer. You will be evaluated on your depth of understanding, level of creativity, and how clearly you are able to
communicate your thoughts.
General Suggestions

The appearance, accuracy, thoroughness, and grammatical correctness of your application will all reflect
you – make sure they all truly reflect the quality of person you are! (Print size 10-12)

Write in a manner, which clearly and effectively communicates to someone who may not be familiar with
4-H. Type the application if at all possible. However, a very neatly printed application in blue or black
ink is acceptable.

Use words that say exactly what you mean or describe exactly what you did. Slang and words like “great”
or “meaningful,” don’t help the reader understand what you actually did or accomplished.

Be sure to dress appropriately for your interview. Jeans and t-shirts are not acceptable. Treat this panel as
though they were a group of prospective supervisors
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Racine County 4-H Trips & Awards Application Cover Page
______________________ 20____
Clover Award
Year
______________________________
Name
___________________________
Club
_______________
Grade in upcoming FALL
Application packet (large envelope) should include:
 This page attached to your Trips & Awards application packet.
 One letter of recommendation in a sealed envelope,. See page 5
 Submit 3 full sets of pages 6-12
 Submit your record book.
 Carefully review the criteria for each trip or award (a description is found in the back of this
packet) and apply for all awards you are eligible for and wish to participate in — you may only
receive one (1) of the asterisked (*) awards in a single year.
 You may be selected for Honor Court and Ambassadors more than once in your 4-H career.
Trip
Award
Title
Clover Award
needed to be eligible
Year awarded the
trip or award
Have you already
attended this event
or participated in
this group?
Check those below
for which you are
eligible & wish to
attend. *Please
Rank-order
preference of trip
(#1 should be your
first choice)
TRIPS
*WI 4-H & Youth
Conference-Madison
*Natl. 4-H Congress
trip Atlanta GA
*C.W.F –
Washington, D.C.
*Natl. 4-H
Conference Nominee
Bronze or higher
Gold or higher
Gold or higher
Gold or higher
AWARDS
Racine County
4-H Ambassador
Future 4-H Leader
Award
Racine County
4-H Honor Court
Racine County
Outstanding 4-H Teen
Wisconsin 4-H
Key Award
Not applicable
Gold or higher
Emerald
Emerald
Emerald
It is the applicant’s sole responsibility to ensure both signatures below
Member: I have read and met the criteria and responsibilities for these awards and I have had my General Leader sign below.
Member’s Signature: ___________________________________
General Leader: I have reviewed this candidate’s Trips & Awards Application and find it to be accurate and complete.
General Leader’s Signature: ______________________________________
4
Trips and Awards Letter of Recommendation (submit one copy)
To the Applicant: Please ask a non-related adult 4-H leader in your club to write a letter of
recommendation. Make sure the person you ask is aware of your achievements in your club. This letter
should focus solely on your club activities and leadership responsibilities. Please fill out the top portion
of this page.
Applicant’s Signature :
Date
Name of Recommender:
__________________
Position Recommender Holds in Club
____________
To the Recommender: Please briefly describe the leadership positions held by the applicant in your 4-H
club. These may include (but are not limited to) club officer, Chairperson/Co-Chairperson of a
committee, Member of a Committee, Junior/Teen leader of a project, and/or leader of an activity. To give
the committee and judges a clear picture of what the applicant does on the club level, make sure to include
what these leadership positions entail (meetings, writing newsletter articles, etc).
You may write on this paper or attach a typed response, making sure to sign and date your letter. Please
return it to the applicant in a signed, sealed envelope OR mail it to the Racine County Extension Office.
5
Trips & Awards Application Forms
Read the application carefully before you begin. For helpful tips, refer to the
suggestions and rules listed in the front of this packet.
Submit 3 sets of
pages 6-12 along with
your record book
Personal Information
Date submit___________________ 20____
Name of 4-H Member__________________________________________________
Your age on Jan. 1, this year____________ Date of Birth_____/_____/_____ Years in 4-H___________
Mo.
Day
Year
(include this year)
Name of 4-H Club to Which You Belong____________________________________________________
Last Grade Level Completed____________ Future Plans_______________________________________
____________________________________________________________________________________
Project Listings
List projects in which you have been enrolled and indicate years and if presently enrolled. Limit yourself
to twelve (12) entries; be selective if needed.
Project
# of Years
Check (√) if
presently enrolled
√ if Jr. Leader
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Please indicate if you have been an active Teen Leader in any project this year:
Name of Project_________________ # of meeting(s) ____
Name of Project_________________ # of meeting(s) ____
Name of Project_________________ # of meeting(s) ____
Name of Project_________________ # of meeting(s) ____
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Section I: 4-H Leadership
Leadership is defined as taking responsibility for planning, arranging, conducting and evaluating
projects and activities. Describe your leadership goals, progress, and how you and others have
benefited from your leadership. Please include your club, county, district and state level leadership
activities.
Give a brief description of one of your leadership roles including your goals, progress and benefits
from your leadership. (Be specific in your example: talk about your role as committee chair for
Holiday Ball or involvement on a committee)
Please be concise. Do not add pages.
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SECTION II (first example) : 4-H PROJECT OR ACTIVITY LEADERSHIP
NARRATIVE
NAME OF PROJECT: __________________________________________________________________
What were your goals in taking this project?
What did you learn by being involved in this project? Discuss personal and hands-on skills.
What were your leadership and/or teaching responsibilities in this project or activity? Please include any
instances from past years of involvement with this activity or project.
Please be concise. Do not add pages.
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SECTION II (second example) : 4-H PROJECT OR ACTIVITY LEADERSHIP
NARRATIVE
Name of project or leadership activity________________________________________
What were your goals in taking this project or activity?
What did you learn by being involved in this project or activity? Discuss personal and hands-on skills.
What were your leadership and/or teaching responsibilities in this project or activity? Please include any
instances from past years of involvement with this activity or project.
Please be concise. Do not add pages.
9
SECTION III: 4-H ACTIVITIES & LEADERSHIP LIST
Years
Club/County/
District or State
Office or Activities
Example:
2009
Club
reporter, pizza chair, committee
NOTE: If you are filling the application out on the computer you may erase the above example
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SECTION IV: NON 4-H ACTIVITIES
(community, church, school activities)
Year
Activities
Example:
2010
Volunteered at AMVETS Annual Pig Roast- Helped with set up and Raffles
2010
Church Youth Group - Camp Counselor
NOTE: If you are filling the application out on the computer You may erase the above example
Describe how you have been able to incorporate 4-H skills within the above listed activities.
Please be concise. Do not add pages.
11
SECTION V: DISCUSSION QUESTION
This section allows you to share your thoughts on a question for which there is no right or wrong answer.
Imagine you were speaking to a group of people who know nothing about 4-H. What would be
the three most important things you would tell them about the program? Be sure to elaborate and
explain why these items are relevant.
Please be concise. Do not add pages.
Good luck to you in your application and interviewing efforts – thank you for your continued interest in 4-H!
12
Trips and Award Descriptions
Updated 07/2015
All trips and rewards require the completion of the Trips & Awards Application and Interview. All directions,
eligibilities, and specifications must be followed completely. Three copies of the Interview form and application
must be submitted, to be reviewed by a panel consisting of three (3) people:
(1) 4-H staff person, (1) outside representative, (1) Board of Directors or 4-H Leader/Alumni representative.
All trip recipients will be required to sign a letter of acceptance and return it to the County Extension Office
along with a deposit. The recipients will participate in all orientation and registration meetings. Once a
commitment is made, you must attend. Exceptions will be given for medical and personal emergencies. The
recipient must act according to the Racine County 4-H Leaders Association Discipline Policy. Recipients are
required to report back to their club and county about experiences and benefits gained from the trip.
Note: If cost is an issue please contact your club leader or the Racine County UW-Extension Office.
**Grades are based on the 2014-2015 School Year
-------------- TRIPS -------------Wisconsin 4-H And Youth Conference
UW Madison Campus in the middle of June. 4 Days/ 3 Nights
Applicant is selected to represent Racine County as a delegate.
Description:
This conference brings together young people in grades 7-10 from around the state to the
University of Wisconsin-Madison campus for four days of learning and fun. This is an
opportunity for youth from a wide variety of backgrounds and experiences to exchange
ideas, form friendships and learn important skills that can be used to contribute to their
communities. Some of the fun and educational workshops are kayaking and other water
sports, art, photography, poetry writing, computers and agriculture.
Cost:
The approximate cost for this trip is $220.00 of which the recipient generally pays 1/2 of
the cost, while the Racine County Leaders’ Association funds the remainder.
Eligibility:
A qualified applicant will have a Bronze record book or higher, be in 7th-10th grades and
display developing leadership qualities. Applicants must also participate in the interview
process. If awarded, the recipient will sign a letter of acceptance and return a deposit to
the UW-Extension office. He or she will also attend one county meeting for registration
and other information prior to attending WI 4-H Youth Conference.
Citizenship Washington Focus (C.W.F)
Washington D.C. in June-July. 9 Days/ 8 Nights
Applicant is selected to represent Racine County as a delegate.
Description:
This weeklong summer trip to our nation’s capitol will increase the participant’s
understanding and appreciation of American Heritage and Government. An opportunity
will be provided to meet with Senators and public or private government officials.
Cost:
The approximate cost for this trip is $1,100 of which the recipient generally pays 1/2 of
the cost, while the Racine County Leaders’ Association funds the remainder.
Eligibility:
A qualified applicant will have a Gold or higher record book and be going into 10th-12th
grade at the time of selection in August. Applicants must participate in the interview
process. He or she will demonstrate leadership skills, sign a letter of acceptance and
return it with a deposit to the UW-Extension office.
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National 4-H Congress
Atlanta, Georgia on Thanksgiving Weekend. 5 Days/4 Nights
Applicant is selected to represent Racine County as a delegate.
Description:
Hands-on experience includes community service, cultural activities, and producing a
national, satellite Town Hall Meeting. The National 4-H Congress Mission is to provide
an intense national leadership forum with a cross-cultural experience for 4-H young
people. National 4-H Congress is the land-grant university systems’ vehicle to expose
youth to current leadership philosophy and research in critical areas (i.e. agriculture,
environment, community, families, youth and children, etc).
Cost:
The approximate cost for this trip is $1,200, of which the recipient generally pays 1/2 of
the cost, while the Racine County Leaders’ Association funds the remainder.
Eligibility:
A qualified applicant will have a Gold record book or higher. He or she must be between
10th – 12th grade at the time of selection in August and be18 years old as of January 1st of
the year in which he or she will be attending. The participant may not graduate from 4-H
during the year of participation. Additionally, the applicant will have outstanding project
work, have been a teen or junior project leader and have demonstrated continued growth
and development in 4-H. If awarded, the recipient will sign a letter of acceptance with a
deposit and return it the UW-Extension office. The recipient will participate in all
orientation activities. Once a commitment is made, you must attend.
National 4-H Conference (nominee)
Washington D.C. in late March or early April. 6 Days/5 Nights
Description:
Six (6) youth are selected state wide to attend this working conference held at the
National 4-H Center. Each county nominates one (1) applicant. Each participate selects
an issue (i.e. education, promotion, environment, etc) and works with other youth from
across the country to develop plans to help direct 4-H programming.
Cost:
The approximate cost for this trip is $1,100, of which the recipient generally pays 1/2 of
the cost, while the Racine County Leaders’ Association funds the remainder.
Eligibility:
A qualified applicant will have Gold record book or higher and be going into the 10th-12th
grade at the time of selection in August, and will not have graduated from 4-H during the
year of attendance. Applicants must participate in the interview process. The nominee
will have displayed outstanding project work individually and as a teen or junior project
leader. He or she will have a broad knowledge of 4-H and have shown consistent growth
in the organization. After signing and returning a letter of acceptance and deposit to the
UW-Extension office, the recipient will participate in all orientation activities. Once a
commitment is made, you must attend.
Award Conflict Standing Rule from Racine County By-Laws
Once a member has been chosen or elected to attend Citizenship Washington Focus, WI 4-H and
Youth Conference, or National Awards, the opportunity of competition for that award is no longer
available to that member, unless its date conflicts with the county fair, or national or state 4-H
participation. If other unforeseen circumstances arise, one must come before the Board of
Directors to obtain permission to interview a second time. If there is a financial hardship, please
contact the County Office for additional assistance.
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-------------- AWARDS -------------Future 4-H Leader Award
Description:
This Award is for youth in grade 7-9 in Racine County 4-H. This award is given to a
youth whom has displayed growth in leadership skills. The member will need to
attend an interview and fill out a Trips and Awards Application.
Eligibility:
A qualified applicant will have a gold record book or higher, be in 7-9th grade and
display potential leadership skills. This member must be on a Club and County
Committee. Applicant must complete an interview.
Racine County 4-H Honor Court
Description:
The Honor Court will consist of youth who have displayed outstanding leadership in 4-H. The
award is designed to recognize those youth who have displayed leadership in their project, club,
county Junior Leaders Association and other 4-H Activities.
Eligibility:
To qualify as a candidate you must have an Emerald record book. He or she will also have been a
Teen or Junior Project Leader and have demonstrated a successful 4-H career (including project
and leadership growth).
Outstanding 4-H Teen of Racine County
Description:
The Outstanding 4-H Teen (s) will be selected from the Honor Court. The recipient(s) should
provide a positive image of 4-H and be a positive role model for youth.
Eligibility:
Qualified applicants will have an Emerald record book, be a minimum of a junior in high school
the year in which the recognition is given. Applicants will have demonstrated a successful 4-H
career, including project and leadership growth, while serving as a Teen Project Leader.
Applicants will have attended an award trip and utilized the leadership experience gained in their
club, county or community. This award may be earned only once.
Responsibilities:
The recipient(s) will represent Racine County 4-H throughout the year at events such as parades
and community happenings; participate where needed at the fair (including the Livestock
Auction). The recipient(s) will be the Master/Mistress of ceremonies at the Holiday Ball and the
Recognition Celebration, as well as be present for limited duties as assigned throughout the year.
Wisconsin 4-H Key Award
Description:
It is a great honor to be selected for the Key Award. This award recognizes a select group of 4-H
members who have demonstrated consistent growth in there
4-H program developed and applied their leadership skills and actively participated in the
functions of their 4-H club and community.
Eligibility:
A qualified applicant will have an Emerald record book and must be at least going into 9th grade
the year in which the recognition is given. Additionally, the recipient will have attended a trip
during the previous year and utilized the leadership experience gained in his or her club, county
or community. Each recipient will have been in 4-H for at least three years and have served for at
least one such year as a teen or junior project leader.
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RACINE COUNTY 4-H AMBASSADOR APPLICATION INFORMATION
Racine County’s Ambassador Program’s purpose is to promote 4-H at community
events throughout the year. In addition to community events, Ambassadors are
seen as leaders at 4-H activities. A 4-H member becomes as Ambassador when
he/she is chosen to represent the 4-H Program in this leadership role. Applicants
may need to attend an interview to be selected.
If you are only
submitting an
AMBASSADOR
APPLICATION
4-H Age: Must be in eighth grade or above
(and not an entire Trips
& Awards Packet),
4-H Members must have the following skills and abilities:
 Mature
 Responsible
 Public Speaking
 Commitment
 Enthusiasm
 A good understanding of 4-H
Ambassador
applicants must
submit pages 12,
17 and 18.
Requirements: Successful applicants must be able to travel around the county and have a sincere desire to
promote 4-H. Each Ambassador must attend at least 75% or more events and 75% of the Ambassadors
meetings and help at the county fair. Failure to do so may result in dismissal from the group.
Duties: To promote 4-H throughout Racine County. Opportunities may include:
1. Promote 4-H in local media with newspaper articles and radio.
2. Attend community events.
3. Visit all clubs once a year.
4. Assist with various events and activities at the fair (i.e. Call Booth, Auction, and Educational
Booths)
5. Help Emcee countywide 4-H events.
6. Visit area schools to promote 4-H.
7. Participate in area parades.
8. Attend Racine County Jr. Leader's Association.
9. Organize trip recipients to speak at meetings.
10. Present and help organize the new family orientation.
11. Community Service Projects.
Selection: Applicants must submit the Ambassador Application form by October 2, 2014 to the UW-Extension
Office (209 North Main St. Burlington WI, 53105). Applicants will be contacted at that time for an interview.
Selection will be limited to a certain number of individuals.
Benefits: Being an ambassador takes a lot of time and commitment, but you can gain the following:
 Increase your knowledge of 4-H
 Improve your self-confidence
 Improve your communication skills
 Gain new leadership skills
 Gain more awareness of your own strengths and capabilities
 Enjoy getting others excited about 4-H
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RACINE COUNTY 4-H AMBASSADOR APPLICATION FORM
Name:_______________________________________________________ Grade:_________
Years in 4-H: ____________ 4-H Club: ______________________T-Shirt Size:___________
I have previously been a Racine County Ambassador _____No ___Yes ____Years as Ambassador
Please provide a short paragraph answer to the following questions. You may type your responses on a separate
sheet of paper if you prefer
1. Why do you want to be a Racine County 4-H Ambassador? If you have already been an ambassador, how
can your previous experience make the Ambassador program better?
2. Name at least three skills or abilities that make you a good fit for the Ambassador program and describe
how they would help in the position.
3. What conflicts may you have that could interfere with your service as a 4-H Ambassador?
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The following is a list of some events the Ambassadors have participated in the past.
Please mark those events you may be interested in:
_____
_____
_____
_____
_____
_____
Presentations to other clubs/organizations in and outside of 4-H (Kiwanis, Rotary, County Board)
Presentation at the New Family Orientation
Promote 4-H at Showcase Night
Emcee Events
Help out at 4-H Events (i.e. Communication Arts Festival, Recognition Celebration, etc.)
Assist in promotional events at the Racine County Fair
_____ Saturday - Large Animal Auction (3 hours)
_____ Sunday - Small Animal Auction (12-3 p.m.)
_____ Educational Opportunities during fair (Tours, WI Ag Jeopardy, Education Tables)
_____ Assist the Outstanding 4-H Youth with appearance and promotions
_____ Chocolate City parade (Burlington) held in May
_____ Independence Day parades held July 4th (Racine, Union Grove, Waterford and Raymond)
_____ Community Service Projects
_____ Racine County Employee’ Events: Santa’s Breakfast, County Picnic etc.
Ambassador meetings are held monthly. Meeting times and location will be determined.
What other commitments do you have that we should know about?
4-Her's Agreement: I have read the duties of the 4-H Ambassador and agree to support the program. If I
don't full fill the requirements (to participant in at least 75% of meeting and events) then I may not take credit
for being an ambassador.
______________________________________
Name
_______________
Date
Parent/Guardian Agreement: I have read the duties of the 4-H Ambassador and agree to support this
applicant if he/she is chosen to represent Racine County 4-H.
_______________________________________
Name
_______________
Date
Applicants must submit the Ambassador Application form along with the Trips & Awards Application packet to
the UW-Extension Office (209 North Main St. Burlington WI, 53105). Applicants will be contacted at that time
for an interview. Selection will be limited to a certain number of individuals.
University of Wisconsin, U.S. Department of Agriculture and Wisconsin counties cooperating. UW-Extension provides equal opportunities in employment and programming including Title IX and ADA.
M:\4H\2015 4-H Files\Trips & Awards\Trips & Awards-Packet-2015.Docx
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