Cooperative Extension University of California Riverside County

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					Cooperative Extension

University of California

Riverside County

ALL STAR APPLICATION
Name: Address
P.O. Box / Street City Zip Code

Date of Birth

/

/

Age

Telephone # (

)

Grade in School

Name of 4-H Club Earned a Gold Star: Yes No

A. On a separate sheet of paper complete an essay on one of the following two topics. Be sure this is sent in with your application. 1. My most memorable 4-H experience (50 to 150 words) 2. Why I want to be an All Star. (50 to 150 words) B. On a separate sheet of paper write about the Community plan you want to complete if you are selected as a 4-H County All Star. Be sure this is sent in with your application. C. List of 4-H Offices Held:

D. List all leadership positions held at: 1. 4-H Project:

2. 4-H Club:

3. 4-H Area:

4. 4-H County:

5. 4-H Regional:

6. Community and School

Continue on Reverse Side

E. If you earned the rank of Emerald Star, please briefly describe the plan you conducted. If you participated in the Citizenship Focus Program please list the program and briefly describe your plan of action you completed.

F. List the Conferences and/or workshops you have participated in.

G. List the Awards, Honors and Recognition’s you have earned or received, that are most important to you, in or out of 4-H. (If in 4-H identify the project area)

H. List participation outside of 4-H (Church, School, Clubs and Community):

The All Star Rank is a working honor, and I fully understand if I am selected I will be expected to fulfill the entire responsibilities set fort to the best of my ability.
4-H member signature Date

As the parent/guardian of this applicant I will help and support the All Star Team and their advisor.
Parent/Guardian Signature Date

4-H Local Club Leader Signature

Date

JL/2006