<p> 4-H Need-a-Computer Application (5 points) PLEASE PRINT! Name </p><p>Address </p><p>City State Zip </p><p>Phone County ______</p><p>Age Grade Teacher</p><p>School </p><p>Do you currently have a computer? Yes No</p><p>Number of people in your household </p><p>Does anyone in your home have a computer? Yes No If yes, do you use it? Yes No </p><p>Check One: Senior 4-Her Junior 4-H’er Cloverleaf 4-Her</p><p>Please list a reference (i.e. minister, teacher, school counselor, etc. - not a relative) and ask them to complete the attached reference form and return by 12/04 or attach to this application. Name </p><p>How do you know this 4-H’er?</p><p>Reference Phone </p><p>Requirement: On an attached sheet of notebook paper, please write a one page essay on: “Why I want or need this computer”. This essay counts for 50 points of your score. APPLICATION CHECK-OFF LIST: Essay Attached (Value – 50 Points) Reference Form Attached or Mailed (Value – 40 Points) Completed Need-A-Computer Application ( Value – 5 Points) Completed 4-H Activities Form (Value – 10 Points) Signature of County 4-H Personnel, 4-H’er and Parent/Guardian ( Value – 5 Points)</p><p> Return completed application, reference, and essay by (County Deadline) to: . Application must be signed by County Extension Agent, 4-H Associate, or 4-H Program Assistant. </p><p> County will mail before 12/04/14 (State Deadline) to: Cheryl Varnadoe, Extension 4-H Specialist, Georgia 4-H, Hoke Smith Annex, University of Georgia, Athens, Georgia 30602</p><p> Computers will be awarded by committee on the basis of need and total application scores. The decisions of the committee are final.</p><p> Those selected to receive a computer will be notified by their County 4-H office. Computers will be picked up at 4-H Fall Forum at Rock Eagle by the county 4-H program. 1 of 2 4-H Need-a-Computer Application</p><p> For more information, call Cheryl Varnadoe at 706-542-4444.</p><p>This program is sponsored by the Georgia 4-H Communications/ Technology Leadership Team.</p><p>List and describe any activities you have participated in with the 4-H club: (10 points) If you are a new member, list what you have done so far. </p><p>READ AND SIGN: I understand that if I am selected to receive a computer that it may not be sold for money or personal gain or given as a gift to others. I understand that it must be returned to my county 4-H office. </p><p>4-H Applicant’s signature </p><p>Parent/Guardian’s signature </p><p>Extension Agent, 4-H Associate or 4-H PA Signature</p><p>Additional Comments by 4-H Staff on this applicant:______2 of 2 4-H Need-a-Computer Application ______</p><p>3 of 2</p>