4-H Alumni Nomination Form

This award is goes to an individual who was a 4-H member in the past and who has made a very special contribution to 4-H through his or her time, influence, or special support. Each Club is eligible to nominate one (1) person for the 4-H Alumni Award. These nominations are due by the first Thursday in June each year.

Name of Nominee:*
First Last
Occupation:*
Name of club of which the nominee is an alumnus:*
Number of years as a 4-H Member:*
In which 4-H projects and activities was the alumnus active?*
How has this individual distinguished him/herself in service to others in his/her adult life?*
Nominated By (please list your name and 4-H club):*
Name
This field is for validation purposes and should be left unchanged.