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Ag Innovators Experience - Teen Leaders & Facilitators Application
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Name (as it appears on your drivers license)
Your answer
Mailing Address
Your answer
County
Your answer
Extension Staff Member You Will Facilitate the Program With:
Your answer
Birth Date
MM
/
DD
/
YYYY
E-mail
Your answer
Grade Level
Your answer
Cell Phone Number
Your answer
Parents/Guardian Names
Your answer
Parents/Guardian Cell Phone Number
Your answer
Have you been a teen leader (county or state) in the Ag Innovator Experience in the past? (ex. Honey Bee, Soils, Monarchs, Water Connects Us All) If so, what qualities did you develop that you will use in future Ag Innovator Experiences?
Your answer
What appeals to you about serving as a teen leader/facilitator for the experience? (ex. leadership, knowledge of the topic, teaching skills)
Your answer
What strengths do you bring as a teen leader/facilitator to the experience? (ex. speaking, organized, etc.)
Your answer
You would be expected to teach at least 50 youth if you are selected. What ideas do you have to reach that many youth and specifically new audiences to 4-H?
Your answer
Are you available to attend our State Training in February (required for State Leadership Team and Facilitators)?
Yes
No
Clear selection
Are you interested in serving on the State Leadership Team? The State Leadership Team attends the National Training in Champaign Illinois and comes back to teach the program to local teen facilitators.
Yes
No
Clear selection
If you answered yes to the above question, and you are selected as a Teen Leader as part of the State Leadership Team, are you be available to travel with an Extension Educator on January 12, 13, & 14 to Champaign, Illinois?
Yes
No
Clear selection
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