Form Nj 4-H - Citizenship Washington Focus Application Form
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2CITIZENSHIP-WASHINGTON FOCUS
APPLICATION FORM
(PLEASE ATTACH A RECENT PHOTO)
March 1
Complete application form and return two copies, and photo to the County 4-H Office by
.
County 4-H Office will send the original application and photo with the County Reservation Form to the State
4-H Office by March 8. County 4-H Faculty/Staff must complete a short recommendation on the last page of
this application.
(Please Print or Type)
Name
Name for Name Tag___________________________
(that matches your Photo ID)
Phone _________________ Soc. Sec.#
Grade
Sex:
M
F
Address
(Street)
(Town)
(Zip)
Email Address__________________________________________ Date of Birth ____________________
NOTE: Photo ID with Birth date is mandatory to attend CWF
Parent’s Signature
Leader’s Signature____________________________
1. You have been asked to complete this application because of your interest and/or involvement in citizenship.
Please explain why you feel you should be selected to represent your county at Citizenship Washington Focus.
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2. List recent leadership, citizenship and community activities in which you have been involved.
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(over →)
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