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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
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Montana
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Nevada
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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 number from
1
to
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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