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Award Application Form
Award Application Form
Bastrop County 4-H Award Application
2017-2018
Award Application:
*
Gold Star (2) - Must be at least 15 as of August 31 of current 4-H year
Silver Star (1) - Senior age 4-H members
I Dare You (1) - Must be at least 9th grade as of August 31 of current 4-H year
Bronze Star - Must be Intermediate. Requires an Interview June 26, 2017.
Outstanding Junior (2)
Outstanding Intermediate (2)
4-H Jacket - 1st place at what District or State 4-H event? Please list in the space below.
4-H Jacket : 1st Place at what District or State 4-H event?
Applicant's Name:
*
First
Last
Nickname, if any:
Address:
*
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
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Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Parent or Guardian's Name:
*
First
Last
Phone:
*
Email:
*
Date of Birth:
*
Grade:
*
Please enter a value between
1
and
12
.
Gender:
Male
Female
Name of 4-H Club:
*
Bastrop 4-H
Bastrop Bulls Eyes Shooting Sports 4-H Club
Bastrop Veterinary Science 4-H Club
Brush Poppers 4-H Club
Loblolly 4-H Club
Lone Star 4-H Club
Rockne 4-H Club
Smithville 4-H Club
My record book this year was entered in the following Awards Programs:
*
List 4-H projects you completed (indicate number years in each project):
*
What do you consider your most outstanding 4-H project and why?
*
List the activities in which your have participated (such as educational presentations, judging contests, camps, leadership labs, state and national activities:
*
List your 5 most outstanding leadership experiences (club, county, district, offices held, committee work):
*
List your 5 most outstanding community service activities in which you participated:
*
List your 5 most important 4-H honors and recognition:
*
Program Narrative in 100 words or less (see example on the Gold Star Program Narrative Instructions):
*
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