Advisory Committee application 2024-25 (extended)

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The State 4-H Advisory Committees provide leadership and offer insight, review and input to the Statewide 4-H Director for the operation and management of the 4-H Youth Development Program.

Advisory Committees are a representative group of 4-H youth, adult volunteers, county and state 4-H staff and program partners.

Name- first and last

County

Address

City

State

ZIP code

Phone

Email address

Date of Birth (youth only)

YYYY

Ethnicity (check all that apply)

Asian/ Pacific Islander

American Indian/ Alaskan Native

Black/ African American

Hispanic/ Latino/a

White

Other

Clear selection

How do you participate in 4-H? (check all that apply)

4-H Club

Camping Programs

School

After-school Programs

Program Partner (school personnel, other youth agency, etc)

Other (if marked, explain below)

Clear selection

Other (please describe):

Years involved with 4-H:

Place of Residence (check one that applies best)

Farm

Rural/ Non-Farm (under 10,000)

Town (10,000-50,000)

Suburb or City (over 50,000)

Clear selection

Which group do you represent?

4-H Member

4-H Adult Volunteer

County 4-H Youth Development Program Staff

State 4-H Youth Development Program Staff

UC Administration

Ex-Officio

Program Partner

Clear selection

If program partner, what organization or entity do you represent?

Clear form

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