Nebraska 4-H Youth Curriculum Committee Online Application Form
Applications Due March 1, 2008
To be completed by individuals applying as a 4-H Youth Curriculum Committee member
Application Information
First Name:
Last Name:
Address:
City:
State:
Zip:
County:
Phone:
Cell Phone: (optional)
Email:
Male / Female:
Male
Female
Age (as of January 1):
Years in 4-H:
4-H Curriculum Area – 1st Choice:
4-H Curriculum Area – 2nd Choice:
4-H Curriculum Area – 3rd Choice:
More Information
I will be able to participate in virtual meetings and activities as stated on the 4-H Youth Curriculum Committee Fact Sheet
Yes
No
If no, explain in the space below.
I will be able to locate an environment that contains a computer with high speed Internet connection, as well as a phone line, allowing me to participate in virtual meetings and activities stated on the 4-H Youth Curriculum Committee Fact Sheet.
Yes
No
If no, explain in the space below.
Name of UNL Extension Staff who will complete the Nominating Form on your behalf.
Please print this page for your records.