2023 4-H Specialty Camps - Teen Leadership Application
Generally, teen leaders must be senior 4-H members (9th - 12th grades). Teen leaders - 4-H members - register and will attend for free.

4-H members complete this form, which the member and parent must agree upon before submitting it to the
county Extension agent. The agent gives comments, signs the form, and submits it to the regional office.
Approval at home, county, and regional levels is required before consideration by the state 4-H staff.
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Email *
Which camp are you interested in working with this summer? *
Choose all that you would like to be considered for.
Required
4-H Teen First Name *
4-H Teen Last Name *
4-H Teen's Cell Phone # *
To which gender identity do you most identify? *
Please select the appropriate box(es) describing your race. *
Required
Please select the appropriate boxes describing your ethnicity. *
Required
4-H Teen's 4-H Agent Name *
4-H Teen's 4-H Agent Email *
4-H Teen's # of years in 4-H *
4-H Teen County *
4-H Teen Region *
4-H Teen Age *
Grade as of January 1, 2023 *
4-H Teen Date of Birth *
MM
/
DD
/
YYYY
4-H Teen Address *
Ex. 000 Clover Lane or PO Box 999
4-H Teen City *
4-H Teen Zip Code *
4-H Teen Parent/Guardian Name *
4-H Teen Parent Cell Phone Number *
Enter a home phone option denoted by Home if you do not have a cell phone, ex - Home Phone 123-456-7890
4-H Teen T-Shirt Size (These will be adult sizes) *
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