2022 State 4-H Camp - Teen Leadership Application
As a general rule, teen leaders must be senior 4-H members. Teen leaders - who are 4-H members - register and will attend for free.

4-H members complete this form, which must be signed by the member and parent 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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E-mailadres *
Which camp are you interested in working with this summer? *
Choose all that apply.
Verplicht
4-H Teen First Name *
4-H Teen Last Name *
To which gender identity do you most identify? *
Please select the appropriate boxes describing your race. *
Verplicht
Please select the appropriate boxes describing your ethnicity. *
Verplicht
4-H Teen's 4-H Agent *
4-H Teen's # of years in 4-H *
4-H Teen County *
4-H Teen Region *
4-H Teen Age *
4-H Teen Date of Birth *
MM
/
DD
/
JJJJ
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 *
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