STATE AWARDS APPLICATION
 
Mail ORIGINAL application (complete with signatures and head and shoulder photo), photo pages, and creative work to: State 4-H Office, 210 Taylor Hall/MSU, P.O. Box 173580, Bozeman, MT 59717 by May 1. Late applications, faxed, or e-mail copies will not be accepted. Application form available in alternate format upon request.
   
 
Awards Program applying for:
Year in which applying: Number of years in project:

  
 
Name:
Address:
City: State: Zip:
Phone: Age on October 1:
County: Club:

   

4-H Member Signature:__________________________________   Date:_________________
 
 Parent Signature:_______________________________________   Date:_________________
 
 Leader Signature:_______________________________________   Date:_________________
 
 

I hearby certify that the record books of this applicant are up to date.
 
 County Agent Signature:_________________________________   Date:_________________
 
 

Paper clip a recent head and shoulder photo of you to this page.

END OF PAGE ONE


SECTION I: COMMUNICATION SUMMARY - 20 Points
Related to Project/Selected Area (8 Points), Communication in Other 4-H Areas (8 Points), Communication Other than 4-H (4 Points). Please title each of these sections with a heading.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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SECTION II: PROJECT GOALS - 10 Points
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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SECTION III: LEARNING- 25 Points
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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SECTION IV: LEADERSHIP- 20 Points
Related to Project/Selected Area (8 Points), Leadership in Other 4-H Areas (8 Points), Leadership Outside 4-H (4 Points). Please title each of these sections with a heading.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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SECTION V: CITIZENSHIP/COMMUNITY SERVICE- 20 Points
Related to Project/Selected Area (8 Points), Citizenship in Other 4-H Areas (8 Points), Citizenship Outside 4-H (4 Points). Please title each of these sections with a heading.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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