Application for Citizenship Washington Focus Delegate

Citizenship Washington Focus 2018 Frontier Extension District Delegate Application

Due August 1, 2016

______Male or Female Name – Please print as you want on name tag (circle one)

______-______-______Social Security Number

______Address – Street and/or Post Office Box Number

______Town/City Zip County

______Phone Number – Include Area Code

______Email Address – Please print clearly

______School Grade

Delegates should: 1). Be responsible and mature youth, 15-19 years of age before January 1st, the year of the trip. 2). Demonstrate leadership qualities, including self-discipline and a sense of group responsibility. 3). Be interested in returning home to apply citizenship concepts to their own lives and the lives of those around them. Citizenship Washington Focus will provide youth the opportunity: 1). To take part in mini-university workshops on contemporary issues and topics. 2). To listen, learn, share, receive, care about and tour with youth from other states and selected resource people. 3). To visit Capitol Hill, government departments, historical sites and memorials.

This application will be reviewed by the Frontier District 4-H PDC. List ways you have contributed to the county/district 4-H program or to the development of your community – assistance to other clubs, county/district events or committees, community service, community resource development and environmental concerns are a few suggested areas.

Describe one issue or concern of special interest to you as a citizen of your 4-H Club or your community. Indicated how you, as an individual or as a member of group, might take action on the issue.

List your other activities (school, church, etc.).

Upon your return, explain how you plan to use information gained from this trip to help/inform other people or local/district clubs. Be specific. Indicate what your specific expectations are for participating in Citizenship Washington Focus.

What is your definition of citizenship?

Summary of 4-H work: Years in 4-H: Years in the Leadership Project: Years in the Citizenship Project: Have you ever been to Washington D.C.? If so, when: Can you secure a doctor’s statement stating your health will permit you to withstand the difficulties of such a trip?

List ways you feel you have helped your 4-H group by serving as a junior leader. BE S PE C IFIC on kinds of help given (i.e.: I served as an assistant project leader in foods.).

Choose and describe one 4-H experience that has given you the greatest sense of satisfaction and enjoyment.