4-H District II Youth Leadership Council
Application for Intent to Run for Office
Name __________________________________________________
Parent/Guardian Name_________________________________________
Mailing Address ______________________________________________
Email Address ______________________________________________
Phone Number __________________ County __________________
4-H Age (age as of September 1, 2004) ___________________________
In the table below, list any offices you have held at the county and/or
district level. You may add an additional page if necessary.
Year Club/ Council Office Held
In the table below, list any other leadership responsibilities you have
held (committees, etc.) You may add an additional page if necessary.
Year Club/Council Responsibility
Why are you interested in running for an office?
____________________________________________________________
____________________________________________________________
____________________________________________________________
Listed below are the district council offices. Put a number beside each
office to indicate your preference (1= highest preference, etc).
ELECTED OFFICES APPOINTED OFFICES
_____ President* _____ Reporter
_____ Vice President* _____ Historian
_____ Secretary _____ Sergeant at Arms
_____ Treasurer _____ Parliamentarian
_____ Junior Ambassador**
_____ Council Delegate*
* These offices require traveling to three (3) State Executive Board Meetings during the 4-H
year. You must be willing to make these trips in order to run for one or more of these
offices.
** This office is the ONLY office that 4-H juniors (ages 8-12) may apply for.
“To the best of my knowledge, I have completed this form as accurately as
possible. I understand that being a district officer is an important
responsibility. If elected, I promise to attend all district council meetings. I
will take my leadership responsibilities seriously, and fulfill them to the best
of my ability.”
___________________________________________________ _________________
Candidate’s Signature Date
I am aware of my son/daughter’s interest in being a District Council Officer
and understand that he/she is assuming, with supervision from my
Extension 4-H Agent, a serious responsibility. I support his/her
participation in this activity, and will do all I can to make sure that he/she
has transportation to district council meetings and events if the 4-H Agent is
unable to go.”
___________________________________________________ _________________
Parent/Guardian’s Signature Date
___________________________________________________ _________________
4-H Agent’s Signature Date
Return this form to the Extension Office no later than April 7th, 2005.