First Time Scholarship to State Congress

Name: ____________________________________________________________

Address: __________________________________________________________

City: _________________________________________ Zip: ________________

Unit: _____________________________________________________________

How long have you been in the 4-H program? ____________(month/year)

Are you a member of a community club _____ or in-school club _____? (check one)

Will this be your first time at Congress? _____yes _____no

Describe how you will share your experience at Congress with youth and adults in your community.  

 

 

 

 

Agent recommendation:  

 

 

 

 

_________________________________________
Signature (4-H'er)

__________________________________________
Signature (Agent)