DOC

4-H State Leadership Conference

By Clifford Greene,2014-05-07 11:53
14 views 0
4-H State Leadership Conference

    2010 4-H State Leadership Conference

    Financial Assistance Information

    Due postmarked May 15, 2010

    Revised 2-3-2010

Through gifts secured by The California 4-H Foundation, the State 4-H Office is able to

    provide financial assistance which will allow youth to attend the 2009 4-H State

    Leadership Conference, July 29- August 1, 2010 at UC Davis

Financial assistance will be allotted on an “as needed and available” basis and is not

    transferable. Delegates may request up to $330 of financial aid. Financial aid selections

    are based on:

    ? Income of the family and family size

    ? Contribution to the diversity of the 4-H State Leadership Conference (e.g. participation in different delivery modes, those requiring special needs, etc.)

    ? Extenuating circumstances such as the death of a parent, parental unemployment, etc.

    ? Preference to those not having received financial aid previously

    ? Those demonstrating an active interest in developing and utilizing skills learned after the conference

    ? Expected transportation costs to the campus hosting the conference based on geographic distance

Upon returning from the conference, all youth receiving financial aid must complete the following:

    ? Write a letter of thanks to the Wells Fargo Foundation. County 4-H Staff will collect these letters and mail them to

    the State 4-H Office in one envelope. Individual postage for each letter will not be necessary.

    ? Include a brief summary describing how the conference experience impacted the delegate and what actions were taken

    after the conference. This will be used to compile a post-conference report to Wells Fargo outlining how their gift

    was utilized, and will help to ensure future donations by Wells Fargo.

    Counties who do not send thank-you letters for each delegate that received funding will receive a bill requesting payment of

    the remaining registration fees.

Incomplete applications will not be considered. Complete applications must consist of both pages of the application. Counties

    will receive notification of funding by May 29. Please mark “Confidential” and fax or mail to:

     Quang “Hogan” Tong

     State 4-H Office 530-752-5644

    UC Davis qtong@ucdavis.edu

     DANR Building, One Shields Ave

     Davis, CA 95616-8575

    We offer our sincere thanks for Wells Fargo’s long-standing support of the 4-H State Leadership Conference that has allowed the State 4-H Office to offer financial aid to youth delegates since 1994. In addition, we wish to thank

    The California 4-H Foundation for its work in securing Wells Fargo’s support.

    County: __________________________________________________________

    Name: ___________________________________________________________

    Age: _____________ Grade: ____________ Gender: ? Male ? Female

    Address: _________________________________________________________

    City: ____________________________________ Zip: _______________

    Telephone: _______________________________________________________

4-H Enrollment Status (check all that apply):

    ? Club ? Special Interest/Short-Term ? Overnight Camping ? Military 4-H ? School Enrichment ? Individual Study ? School-aged Child Care

Ethnicity (check one that applies best):

    ? White ? Black/African American ? Hispanic/Latino ? Asian/Pacific Islander ? American Indian/Alaskan Native ? Multi-Ethnic

Place of Residence (check one that applies best):

    ? Farm ? Rural-Non Farm (under 10,000) ? Town (10,000-50,000)

    ? Suburb of City (over 50,000) ? City (over 50,000)

Mark years of previous financial aid/scholarships you have received:

    ? None ? 2009 ? 2008 ? 2007 ? 2006 ? 2005 ? 2004

Amount Requested: $_________ ($330 maximum)

    Please answer the questions below on an additional piece of paper.

    1. Why are you interested in attending this conference?

    2. What do you hope to accomplish after the conference with the information you will have learned?

As part of your attendance at this conference, you are required to send a thank-you letter to the Wells Fargo Foundation after

    you return. By signing below you agree to this commitment and the accuracy of the information provided.

Signature of Applicant: __________________________________________________ Date: ____________

I verify that this individual is enrolled as a 4-H member in my county.

Print Name: ___________________________________________________________________________

Signature of 4-H Staff: __________________________________________________ Date: ____________

    2

These questions will be used in selecting youth to receive financial assistance for the 2009 4-H State Leadership Conference.

    Applicant’s Name: ________________________________County: _______________________________

Our annual family income is:

    ? Below $15,000 ? $15,000 to $30,000 ? $30,000 to $40,000 ? $40,000 to $50,000

    ? $50,000 to $60,000 ? $60,000 to $70,000 ? $70,000 to $80,000 ? $80,000 and above

    Our family is: ? A single-parent household ? A two-parent household

The number of dependents in the house _____________________

Please mark all that apply:

     ? Temporary Assistance to Needy Families (TANF)

     ? Food Stamp Program

     ? Section 8 Housing

     ? Attendance at a Chapter I School and a school where 50% of the youth receive free lunches

     ? Free school lunch and/or breakfast program

     ? MediCal Card

     ? Foster Care or Group Home

     ? Neighborhood Youth Corp (NYC)

     ? Summer Youth Training Employment Program (SYTEP)

     ? MESA - minority low-income math and science education

     ? California Conservation Corps

     ? Family member in Head Start

     ? Other: __________________________________________________________________

Please add any additional comments and explain any extenuating circumstances.

By signing, I confirm the accuracy of the information provided.

Signature of Applicant: __________________________________________________ Date: ____________

Signature of Parent/Guardian: ______________________________________________Date: ____________

     3

Report this document

For any questions or suggestions please email
cust-service@docsford.com