<p> National 4-H Conference Delegate Application</p><p>DUE: October 2, 2017, 5 p.m. Send to: Kansas State 4-H Office 1612 Claflin Road 201 Umberger Hall, KSU Manhattan KS 66506-3404</p><p>To apply, ALL of the following must be in the State 4-H Office by October 2 at 5 p.m.:  This application page  A cover letter introducing yourself and explaining why you want to be a National 4-H Conference delegate (one page maximum)  A résumé highlighting relevant experiences, skills, awards, etc. (one page maximum)  Two recommendation forms and letters of reference completed by an Extension Agent or/and 4-H Volunteer not related to the applicant. Recommendations should be mailed separately by the evaluator. </p><p>Applicants will be notified by November 1 if they have been selected to interview at the Kansas Youth Leadership Forum.</p><p>First & Last Name</p><p>County/District </p><p>Mailing Address Street City ST Zip E-mail Address </p><p>Home Phone Year in School </p><p>Mobile Phone Age Jan. 1, 2018</p><p>Yes No Will you be attending the 2017 Kansas Youth Leadership Forum? (Required) Yes No Have you completed the Volunteer registration process with your local Extension Office? (Required prior to Citizenship in Action) Yes No Have you served on any Kansas State 4-H Action Teams or other state-wide leadership groups? If yes, please list below:</p><p>I recommend the youth named above as Kansas delegate for National 4-H Conference. I believe this individual is trustworthy, respectful, responsible, fair, and a caring citizen who will be an actively contributing team member for this conference. My signature indicates my support for their application and verifies that if this member is selected, they will have completed the Volunteer Registration process in our county/district prior to the 2018 Citizenship in Action event.</p><p>Extension Agent’s Signature Date</p><p>National 4-H Conference Delegate Agreement Form</p><p>If I am selected as a Kansas youth delegate to National 4-H Conference, I agree to the commitments listed below:</p><p>1. Provide $1300.00 toward National 4-H Conference fees ($500 deposit due February 1 and the remaining $800 by March 15). The remaining expenses are paid by a grant through the Kansas 4-H Foundation. Often times your 4-H Club, 4-H Council, local 4-H Foundation or other community organizations will help to fund your fee. </p><p>2. Serve two years on the Kansas 4-H Youth Leadership Council. I agree to attend the Kick-Off Retreat January 6-7, 2018 when my term begins.</p><p>3. Participate in orientation prior to National 4-H Conference (usually held in conjunction with the Youth Council retreat in January). I realize I will not receive reimbursement for travel to the orientation site.</p><p>4. Represent Kansas 4-H to the best of my ability at National 4-H Conference; sharing ideas from Kansas and learning ideas from other states.</p><p>5. Assist with the Citizenship in Action, Kansas Youth Leadership Forum, Emerald Circle Banquet, Friends of 4-H Day, Campference, Kansas State Fair and/or other state 4-H events as requested.</p><p>6. Take initiative in helping 4-H members become more involved in Kansas 4-H Program activities and decisions.</p><p>Signature of Applicant Date</p><p>Signature of Parent or Guardian Date</p><p>NOTE: Applications will be screened and selected applicants will be notified by November 1 as to their invitation to interview. Interviews will be held on November 18, 2017 at Rock Springs 4-H Center in conjunction with the Kansas Youth Leadership Forum (attendance is required).</p><p>2 National 4-H Conference Recommendation Form</p><p>Received by: October 2, 2017 Send to: Kansas State 4-H Office 1612 Claflin Road 201 Umberger Hall, KSU Manhattan KS 66506-3404</p><p>You have been asked to provide a recommendation for a 4-H’er who is applying to serve as a National 4-H Conference delegate representing Kansas. To complete this reference, please send the following documents, separate from the 4-H’ers application to the State 4-H Office (address above) by Monday, October 2:  This recommendation form  A letter of recommendation explaining how you’ve worked with the applicant and their relevant skills and abilities. (one page maximum)</p><p>Applicant Name </p><p>Reference Name </p><p>Please check the column that best describes this youth’s characteristics.</p><p>B A e b l o E U o A v x n w v e c P k e e o n A r A l o o v a v l r w e g e e n r e r n a a t g g e e Optimistic/Positive Attitude</p><p>Work Habits</p><p>Organizes Time and Work</p><p>Interpersonal Skills</p><p>Listening Skills</p><p>Creative/Innovative</p><p>Tactful/Courteous</p><p>Dependability/Promptness</p><p>Maturity/Poise Honesty/Integrity</p><p>4</p>