CongratulationsonbeingselectedtoserveontheState4HScience,EngineeringandTechnologyBoard. ItisanhonortobeselectedontheSETBoard,butitisalsoabigresponsibility.Asweembarkona successfulyear,itwilltakecommitmentandeffortoneveryonespart.Throughoutthisyearwewill worktowardsexcellenceinleadershipandteamwork.Yourexperienceswillbetterprepareyouinareas ofscience,engineering,andtechnologyalongwithprovidingyouwithimportantlifeskills.Thisisan opportunityforyoutotakeyourleadershipexperiencesfromaparishleveltoastatelevel.Welook forwardtoworkingwithyouthisyearandareheretoassistyouatanytime.Pleasefeelfreetocontact anyoftheSETBoardAdvisorsbyemailorphoneasneeded. Thefollowingpacketcontainsimportantinformationpertainingtoyourpositionasaboardmember. Wehavetriedtoincludeinthispacketalloftheboardeventdates,deadlinesandformsyouwillneed throughouttheyear.Takethetimetoreadeachpagecarefullyandfollowtheinstructionsasspecified. Reviewcarefullytheboardrequirements.Thisisacommitmentoftimeandrequirespersonal dedication.WhenpossibleallcommunicationfortheSETboardwillbeconductedbyemailandresponse isexpectedwithin5daysorbydaterequestedintheemail.Someoftheformsinthismembership packetaredueBEFORE4HUniversitysopleasemakesureyouareawareoftheduedateforeachform.

. Byacceptingapositionontheboardyouarecommittingtocompletingallrequiredboardactivities.We understandthatascommunityleadersyouhavemanyresponsibilities.Ifyouhaveotherresponsibilities thatconflictwithrequiredboardeventspleaseallowanother4Hmemberwhocanfulfillallofthe boardrequirementstofilltheposition.Asaboardmemberyouwillberequiredtoattendthesummer boardmeeting(July68,2011),completeaparishproject,participateintheservicelearningprojectand takeonatleast1otherboardduty.Throughouttheyearyouwillhaveopportunitiestoparticipatein additionalactivitiesandprovideleadershiptomembersthroughoutthestate. Important4HUniversitynote:Ifyouhavebeenaskedtoactasavotingdelegateforyourparish,please letyouragentknowyouwillnotbeabletofulfillthatpositionsotheycanselectanalternate.Youwill needtobepresentfortheboardmeeting.Ifyouareapplyingforanotherboardyouwillneedtonotify theadvisorforthatboardofyouracceptanceofapositiononthisboard. Anyformsdueduringtheyearshouldbefaxed,emailedormailedtothefollowingaddress: FaxNumber:2255787847 Email:Awmullens@agcenter.lsu.edu Mail:AshleyMullens,POBox25100,BatonRouge,LA70809 Pleasenotethatformsshouldbemailedatleast35daysPRIORtotheduedate. PacketContents SETBoardContractSignatureofthisformsignifiesacceptanceofposition.Thiscontractshould besignedandreturnednolaterthanJune15,2011. OfficerPositionsandApplicationsIfapplying,applicationmustbesubmittednolaterthanJune 15,2011.Emailpreferred.BeinganofficerisagreatwaytocontributetothesuccessoftheSET boardandtoensureameaningfulexperienceforyourself.SETboardofficerswillbeinvitedto participateintheSouthernRegionTeenLeadershipConference(Oct.1316,2011)andthe Governorsdinner(June5,2012).

HealthFormandCodeofConductTheseformswillbedueforeacheventyouattendasaSET boardmember.Itisrecommendedthatyoukeepafewcopiesreadytogo.Acopyofthese formsisdueJune15forthesummerboardmeeting. ParishProjectInformation EventsandImportantDates

20112012BoardAdvisors AshleyMullens,StateOffice awmullens@agcenter.lsu.edu 2255782196 AllpaperworkandquestionsregardingpaperworkshouldbesenttoAshleyMullens. KatinaHester,AscensionParish khester@agcenter.lsu.edu(preferred) 5306437837textcapable DavidBoldt,StateOffice dboldt@agcenter.lsu.edu 2255782196 RubyMiller,CameronParish rmmiller@agcenter.lsu.edu 3373919552textcapable JoannaStrong,RichlandParish jstrong@agcenter.lsu.edu(preferred) 3187283216 3182826273(textcapable) CynthiaPierfax,EastCarrollParish cpierfax@agcenter.lsu.edu 3185591459 AlexShook,BossierParish ashook@agcenter.lsu.edu 3189652326

SET Board Activities and Due Dates

Itistheresponsibilityofeachboardmembertoknowthedatesbelow.Remindersofupcomingdue datesandpaperworkneededarenotguaranteed.Pleaseplacethesedatesonyourcalendarforthe upcomingyear. CopiesofthisandadditionalannouncementswillbepostedtotheSETboardFacebookgroup.Ifyoudo nothaveaccesstoFacebookpleaseletusknow. Pleasenotethatofficerswillbegivenanadditionallistofduedatesrelatedtotheirpositionupon election. Anyformsdueduringtheyearshouldbefaxed,emailedormailedtothefollowingaddress(unless indicatedotherwise): FaxNumber:2255787847 Email:Awmullens@agcenter.lsu.edu Mail:AshleyMullens,POBox25100,BatonRouge,LA70894 Pleasenotethatformsshouldbemailedatleast35daysPRIORtotheduedate. WhathappensifIcantmakeaneventorcompletearequirement? Ifyouareunabletocompletearequiredboardactivityyouwillbeputonprobationandwillhaveto completenextrequiredactivityorwillbedismissed.Ifyouhaveareasonyoucannotattendthatyou feelshouldbeexcusedyoumustsubmitaletterfromyourparentoradultresponsiblestatingwhyyou cannotattend.Lettersmustbesubmittedbydateindicatedinlistbelow.Advisorswillreviewexcuse letterandletmemberknowiftheyareexcusedwithin3days.Ifafamilyemergencyoccursthatcauses youtomissatthelastminute,lettermustbesubmittedbyparentexplainingthecircumstancewithin10 daysofeventmissed.AnyboardmemberdismissedfromtheboardafterAugust1isineligibletoapply for1fullyearortoattendtheboardeducationtrip.Pleasenote:familyvacationsandothereventsthat youcouldhaveplannedforwillnotbeexcusedsinceyouaregiventhedatesforallupcomingevents priortoacceptingyourposition.Computerissueswillnotbeacceptedasanexcuseforfailuretoturnin anyitems.Itemscanbehandwrittenandmailed,faxedorcalledinifneeded. QuarterlyReports Throughoutthetimelineyouwillseearequestforquarterlyreports.Thesearenotrequiredbutare stronglyencouraged.Thereportservestoletyourregionalrepresentativeandboardadvisorsknow aboutleadershipyouareprovidingonalocalorregionallevel.Thesereportswillbeusedtoaddtothe newsletter,updateourwebsiteandhelpseeksponsorshipsforourboard. Itemsinitalicsareforyourinformationonlyanddonotrequireanyactiononyourpart.ItemsinBold arerequiredboardactivities. 2011 June15

SETBoardContract,HealthForm,CodeofConductandmembershipfeedue. Membershipfeemustbecheck/moneyordermadeouttoLouisiana4HFoundation. o Officerapplicationsdue. June16 o CopiesofofficerapplicationswillbepostedtotheSETBoardFacebookgroupforall boardmembersforreview. June21 o SETBoardBusinessmeeting.PresidentandVicePresidentwillbeelected.Members missingthemeetingareresponsibleforcommunicatingwithboardpresidenttogetany importantinformation.1:303pm,CastilianRoom(LSUUnion). July1 o SummerboardmeetingagendawillbepostedtoFacebookgroup. July68 o SETboardleadershipretreatandsummerboardmeeting(Woodworth,LA). TransportationpickupwillbeprovidedfromBatonRouge,LAandLafayette,LA. Membersmissingmeetingwillbedismissed.Therearenoexcusesallowed.Ifamember missesthemeetingduetoafamilyemergencytheywillstillbedismissedbutwillbe eligibletoapplythefollowingyear. o HealthformandcodeofconductforLOSTcampdueatmeeting. o WorldsFinestChocolatecheckdueforchocolatepickupatLOSTcamporOMKCamp. July31August5 o LOSTcamp.BoardmemberswillarriveatCampGrantWalkerSunday,July31by5p.m. CampersarriveAugust1. o OfficersRetreat.OfficersshouldarriveSundaymorningby10amforanofficers leadershipretreat. Aug.17 o HealthformandcodeofconductdueforOMKSETCamp. Aug.2628 o OMKSETcamp. o FinaldetailsforboardServiceLearningprojectwillbegivenoutandpostedto Facebook. DATETBA(Fall2011) o ServiceLearningProject October o National4HScienceExperiment.Makeplanswithparishtohelphostexperimentat parishand/orclubevent(s).Greatparishproject! Oct.21 o Ifattending4Htailgatesubmithealthform,codeofconductandtailgateattendance form. o Quarterlyreportdue.IncludeNational4HScienceDayactivities,JulyOctactivitiesyou didalongwithnumberofyouth,date,location,etc o Heathformandcodeofconductdueforroboticstournament. November12. o

4HFootballgame.Boardmembershavetheopportunitytowalkonthefieldatpre game. o SubmitsignedProgramPlanningSheetforparishprojectifyouhaventalready conductedtheevent. NovemberDateTBA. o CentralRegionFirstLegoLeagueTournament. Dec.15 o Healthform,codeofconductandattendanceformforWinterBoardMeetingdue. o WorldsFinestChocolatecheckdueforchocolatepickupatWinterBoardMeeting. 2012 o Jan.67 o WinterboardmeetingatCampGrantWalker.Boardmembersarriveby5pmFriday. Depart11amSunday.Transportationshouldbearrangedbyboardmembers(check withparishorothermembers). o Quarterlyreportdue,includeOctoberDecemberactivities. March1 o LOSTCampLessonplanfirstdraftduetoadvisorsandLOSTcampcoordinator April1 o ParishprojectarticleandphotoduetoKatinaHesteratkhester@agcenter.lsu.edu. o Quarterlyreportdue,includeJanMarchactivities. April15 o FinaldraftlessonplansandbudgetdueforLOSTcamp.Budgetandfinallessonplanwill bereviewedandrevisionrequestssentout.Committeereportsdue. May30 o FinalLOSTCampLessonplansandbudgetdue.Lessonactivitiesshouldbecompletely testedbythisdate. June15 o FinalQuarterlyReportDue,coveractivitiesfromAprilJune.

Description of Events
SummerBoardMeetingThismeetingistheintroductorymeetingfortheboard.Boardmemberswill participateinteambuildingactivities,leadershiptrainingandprepareforupcomingeventsincluding LOSTcamp,OMKSETcampandservicelearningproject. LOSTCampThisistheSETcampfor7th&8thgraders.TheSETboardplaysalargeroleinLOSTcampby sponsoringandleadingeducationaltracksandeveningassemblies.Theboardwillalsosetthetheme andplananyspecialactivities. OMKSETCampTheSETboardhoststheOMKSETcamp.Thiscampisformilitaryyouthages518. Duringthiscamptheboardwillalsohaveanopportunitytohostashortmeeting. 4HFootballGame/DaywithTigersBoardmemberswillwalkontoTigerfieldduringhalftimeandwill helpwithactivitiesandboothsatthetailgatepriortothegame.

WinterBoardMeetingBoardmemberswillmeetatCampGrantWalkerinJanuary.Memberswill planforLOSTcampbysettingthetheme,determiningtracksandorganizingtrackteams.Memberswill completelessonplanoutlinesatthemeeting.Membersmaychoosetodothesametracksaslastyear orcompletelydifferenttracks.MemberswillalsoworkonpresentationforJLCandanyotherbusinessas determinedbythePresidentandboard. ParishSETLeadershipProjectEachboardmemberwillneedtoplanand/orleadaparishSETrelated activity.Thiscouldbeasciencecamp,livestockprojectday,contest,SETClub,etcThiscanbea1day eventormonthlyclubaslongasatleast10youtharereachedandtheboardmemberisthelead person.BoardmembermustwriteanewsarticlewithphotoandsubmittoKatinaHester, khester@agcenter.lsu.edubyApril1.Additionalguidelinesapply.SeeParishProjectGuidelinessheet. SETBoardFacebookSiteTheSETBoardhasafacebooksitewillbeusedtocommunicate announcements,changes/additionsofdates,andotherboardbusinessinformation. FlickrPhotoGroupThe20082009boardestablishedaFlickrPhotoGroupthathostsamonthly themedcontest.Aboardmembercantakeresponsibilityforpickingathemeandmonitoringthisgroup. ServiceLearningProjectTheboardasawholewilldecideuponandconductaservicelearningproject. Thismightbeaneventtheboardmeetstogetherforormightincludetasksassignedformembersto completeonaparishlevel. CentralRegionFLLRoboticsTournamentBoardmembershostthecentralregionFirstLegoLeague roboticscompletion. EducationTripDuringthesummerof2013boardmembersfromthe20112012and20122013year whowereingoodstandingasofJune1oftheirtermyearwillbeinvitedtoparticipateinasummer educationalboardtrip.MemberswillgotoDisneyinOrlandoandparticipateintheDisneyYESprogram Estimatedcostsare~600800perperson.Boardmemberswillbegivenopportunitytodoboard approvedpersonalfundraisersthroughouttheyeartoraisemoneyforthetrip. WorldsFinestChocolate BoardmembersmayconductWorldsFinestChocolatefundraiserinordertoraisefundsforthe EducationalTrip.Boardmembersmustmakesuretheiragentisawareandapprovesandshouldrefrain fromsellingchocolateatparish4Heventsunlessgivenpermissionbythe4Hagent.Personal fundraisingshouldnotinterferewithfundraisingeventsbyyourparish.AllmoniesMUSTbeusedforSET boardeducationtrip.Note:Thereisaminimumorderthatmustbemetbythecompany.Youwillbe responsibleforpickingupyourchocolatefromthepickuppointorBatonRouge. Miscellaneous Eachboardmemberwillselectadutyfortheyearthattheywillbeexpectedtocompleteinordertobe amemberingoodstanding.Theselectionswillbemadeatsummerboardmeeting.

20112012 Officer Positions

Ifyouareinterestedinapplyingforoneoftheavailableofficerpositions,pleasereadthislettercarefully.Any memberiseligibletorunforoffice.BoardmembersrunningforPresidentorVicePresidentMUSTbepresentatthe 4HUniversitybusinessmeeting.ThebusinessmeetingwillbeheldTuesday,June21from1:303:00p.m. Toapply,completetheappropriateapplicationandmail,fax,oremailtothe4HStateOfficebyJune15.Youmay applyformultiplepositions,butmustfilloutaseparateapplicationforeach.ApplicationMUSTbelegible(typeor printinink)oritwillnotbeconsidered.Applicationswillbemadeavailabletoallboardmemberspriortoelections. ThePresident,VicePresident,Secretary,ReporterandSr.CampCoordinatorwillbeinvitedtoattendtheSouthern RegionTeenLeadershipConferenceOctober1316,2011inCrossville,TN.Allofficerswillbeinvitedtoattendthe GovernorsdinnerinJune2012dependentonspotsavailable.Iftherearenotenoughspotsforallofficers,seatswill bebasedonseniority(gradelevel).OfficialboardmeetingsmentionedbelowincludeSummerBoardMeetingand WinterBoardMeeting.Additionalmeetingsmaybeadded.

Positions Available
President ThePresidentwillserveastheleaderfortheboard.Presidentwillworkwithboardadvisorstosetmeetingagendas andleadallboardmeetings.Presidentwillberesponsibleforboardcommunications.Mustattendallofficialboard meetings.MUSThaveandcheckemailregularly.Mustbeenteringyourjuniororsenioryear.Presidentwillalsobe askedtogiveaspeechattheGovernorsdinnerandmaybeaskedtorepresenttheboardatotherpublicfunctions. VicePresident TheVicePresidentwillhelpthePresidentwithleadershipoftheboard.VicePresidentwillberesponsiblefor planningandcoordinatingtheboardservicelearningproject.MUSThaveandcheckemailregularly.VicePresident willbeexpectedtocompleteaservicelearningcourseandbecommittedtoprovidingaqualityserviceexperience fortheboard. Secretary Thesecretarywillbetakeminutesatallmeetingandsubmitminutestotheboardmember.Minutesmustbe submittedwithintwoweeksoftheevent.Mustattendallofficialboardmeetings. Reporter Reporterwillberesponsibleforwriting/coordinatinganewsstoryonallofficialboardeventsincludingLOSTcamp, OMKSETcamp,National4HScienceexperiment,4HTailgate,andtheservicelearningproject.Reportermayneed totakephotographsofeventsforstoriesalso. LOSTCampCoordinator Thisisa2yearpositionandcommitment.SeniorLOSTCampCoordinatorwillberesponsibleforleadingplanningfor eveningassemblies.JuniorLOSTCampCoordinatorwillberesponsibleforleadingtrackplanning.Mustattendall officialboardmeetings. RegionalRepresentative Numberofpositionsperregionwillbedeterminedbymembershipnumbers.Theregionalrepresentativewillbe responsibleforcommunicatingwithboardmembersintheirregion.Theregionalrepwillworkwiththe4HRegional Coordinatortoidentifyopportunitiesforboardmemberleadership.Regionalrepswillberesponsiblefor writing/collectinganarticleforeacheditionoftheboardnewsletter.

President Application Form

Name:____________________________________ Grade:________ Yearsin4H:______ Parish:____________________________ Email:____________________________

Answerthefollowingquestionsonaseparatesheetofpaper.Pleasetypeandemailifpossible. 1) OfficerPositionsHeld: 2) Pleasedescribeindetailanexamplewhereyouwereresponsibleforleadingagrouporteam.Talkabout methodsusedtocommunicateandmotivate. 3) Tellusyourvisionforleadershipoftheboard.Bespecificingoalsyouwouldliketoaccomplishandhowyou wouldimplementthegoals. 4) Characterisanimportantpartofbeingagoodleader.Writeabriefparagraphdiscussingthetraitsofgood characterandwhycharacterisimportantasaleader. 5) TelluswhyyouthinkyouwouldyouwouldmakeagoodPresident. 6) Whatdoyouthinkisthebestwaytocommunicatewithboardmembers? Ifpossible,pleasehaveyour4Hagentemailorfaxaletterorstatementofrecommendationforyouinthis position.

VicePresident Application Form

Name:____________________________________ Grade:________ Yearsin4H:______ Parish:____________________________ Email:____________________________

Answerthefollowingquestionsonaseparatesheetofpaper.Pleasetypeandemailifpossible. 1) OfficerPositionsHeld: 2) Pleasedescribeindetailanexamplewhereyouwereresponsibleforleadingaservicelearningproject.Talk aboutmethodsusedtoorganizeandmanagetheproject. 3) DescribeapossibleservicelearningprojectyouwoulddowiththeSETboardandgivedetailsonhowyou wouldimplementtheproject. 4) TelluswhyyouthinkyouwouldyouwouldmakeagoodVicePresident. Ifpossible,pleasehaveyour4Hagentemailorfaxaletterorstatementofrecommendationforyouinthis position.

 Reporter Application Form

Name:____________________________________ Grade:________ Yearsin4H:______ Parish:____________________________ Email:____________________________

Answerthefollowingquestionsonaseparatesheetofpaper.Pleasetypeandemailifpossible. 1) Haveyouservedasareporterforanorganizationbefore?Ifyes,listposition,organizationandyear. 2) AreyoucurrentlyorhaveyoupreviouslyenrolledintheCommunicationorBroadcastandPrintJournalism projects?Describewhatyoulearnedorlistotherexperiences/projectsthathavecontributedtoyourskillsas areporter. 3) Submitanexamplestory.Inthespacebelowtellusaboutwhatmethodsyouusedtowriteyourstory including:anyinterviewsobtained,howyouobtainedyourstoryinformationandwhathappenedtothe storyafterwards. 4) TelluswhyyouthinkyouwouldmakeagoodreporterfortheSETBoard? Ifpossible,pleasehaveyour4Hagentemailorfaxaletterorstatementofrecommendationforyouinthis position.

Secretary Application Form

Name:____________________________________ Grade:________ Yearsin4H:______ Parish:____________________________ Email:____________________________

Answerthefollowingquestionsonaseparatesheetofpaper.Pleasetypeandemailifpossible. 1) Haveyouservedasasecretaryforanorganizationbefore?Ifyes,listposition,organizationandyear. 2) Areyoucurrentlyorhaveyoupreviouslyenrolledinaprojectbookrelatedtothepositionofsecretaryor treasurer?Describewhatprojectsandwhatyoulearned. 3) Telluswhyyouthinkyouwouldmakeagoodsecretary/treasurerfortheSETBoard? Ifpossible,pleasehaveyour4Hagentemailorfaxaletterorstatementofrecommendationforyouinthisposition.

 LOST Camp Coordinator Application

Name:____________________________________ Grade:________ Yearsin4H:______ Parish:____________________________ Email:____________________________

Answerthefollowingquestionsonaseparatesheetofpaper.Pleasetypeandemailifpossible. 1) LeadershipPositionsheld(juniorleaders,clubpresident,eventchair): 2) Describeanevent,workshoporlessonyouwereresponsibleforplanning.Talkaboutwhatyoudidtoplan, organizeandcommunicate.Talkaboutanycreativeideasyoucameupwith.Pleasebeverydetailedwithall partsoftheplanningandimplementationoftheevent. 3) Giveanexamplewhereyouleadateamandhadtomeetdeadlines.Describemethodsusedtoplanand motivate. 4) TelluswhyyouthinkyouwouldmakeagoodLOSTCampCoordinator. Haveyoubeento4Hcamp?YesNo Haveyouservedasacampcounselor?YesNo AreyouCampCounselortrained?YesNo Canyoucommitto2yearsofattendingLOSTcampandservinginthisposition?YesNo Ifpossible,pleasehaveyour4Hagentemailorfaxaletterorstatementofrecommendationforyouinthisposition.

Regional Representative
Name:____________________________________ Grade:________ Yearsin4H:______ Parish:____________________________ Email:____________________________

Answerthefollowingquestionsonaseparatesheetofpaper.Pleasetypeandemailifpossible. 1) Howoftendoyoucheckemail?Whatdoyouthinkisthebestwaytocommunicatewithboardmembers? 2) Describeapossibleleadershipopportunitymembersinyourregioncouldparticipateinorimplement. 3) Listactivitiesyouhavedonewithinthepastyearonaparishorregionallevel. 4) Whydoyouthinkyouwouldmakeagoodregionalrepresentative? Ifpossible,pleasehaveyour4Hagentemailorfaxaletterorstatementofrecommendationforyouinthisposition.

ParishProjectInformation
BeinganactiveleaderonalocallevelisanimportantpartofbeingaStateSETboardmember.Allboard membersmustcompletetheProgramProposal(Seeprogramproposalsheetguidelines)fortheirparish projectbyNovember12th.EachmemberisREQUIREDtocompleteaparishprojectandturninanarticle withphotonolaterthanApril1,2012.Aparishprojectiseventsoractivitiesinwhichyoutakea leadershiprole.Aparishprojectshouldmeetatleast10youthandbeatleast12hoursinlengthtotal. Thiscouldbethrough1singleeventormultiple.Ideascouldinclude(butnotlimitedto): SETorSETrelatedprojectclub Conductingaworkshoporminicamp RunningSETrelatedcontest ConductingtheNationalScienceExperimentinyourparishwithdifferentgroups Helping4Hmemberswiththeirprojects(SETrelated)

ItisstronglyencouragedthatyouNOTplanyourparishprojectforthemonthofMarchasthisisan extremelybusytimeofyearinmostparishes.Begintalkingtoyouragentasearlyaspossibleinthefall aboutyourparishprojectandideas. WriteUpRequirements Yourwriteupmustbeatleast2paragraphsinlength(nolessthan12sentences)andshouldcoverthe followingdetails: Boardmemberswhodonotcompletethisrequirementwillbeineligibletoapplyfora2ndterm.Ifthe boardmemberhasalreadymissedanotherrequiredactivity(summerboardmeeting,servicelearning project,boardmemberduty)thentheywillbedismissed. Dateofevent Locationofevent Titleofevent Numberofkidsinattendance Detailsoftheactivity(whatyoudid,whatthekidslearned,howitrelatestoSETand4H) Aquotefromaparticipantabouthowtheeventaffectedthem Aphoto Aquotefromyouaboutyourexperience

EventProposalOutlineforStateBoardMembers Suggestionsforeventsshouldincludealltheinformationrequestedbelow.Proposalswillbeevaluated byyourparish4HYouthDevelopmentAgent,4HRegionalCoordinator(ifproposingaregionalevent), andyourStateBoardSponsor.Allpartiesmustapprovetheeventbeforetheplanningprocessbegins. Pleaselimitthetotalproposaltonomorethantwo(2)pages. Team: o Pleaselistallmembers(bothYouthandAdults)thatwillserveontheeventplanning committee.

EventDescription: o Includeabriefdescriptionofprogram/activitythatyourteamwantstoputintoaction.

NeedsBase: o o Howwastheneedforthiseventidentified? Whatwillthiseventaccomplish?

EventOutline: o o o o WhatWillBeDone? ByWho? When? Where?

Funding: o o o WhatdoyoupredicttheEventcosting? Aretheresponsorsthatwouldbeinterestedinsupportingthisevent? Whereisthemoneytobekept?

Agentssignature:___________________________ RegionalCoordinatorsSignature(ifrelevant)*:___________________________ BoardSponsorsSignature*:___________________________

*Approvalcanbegrantedviaemail

Event Reflection Sheet

Keepingarecordofyouractivitiesasaleaderisimportant.Thissheetisforyourusetorecord informationaboutactivities/eventsyoulead.Thesesheetscanbeusedaspartofyour4Hportfolio and/orturnedintoyourregionalrepresentativeand/oradvisorsasarecordofyourleadershipasa boardmember.Boardmembersseekinga2ndtermwiththeboardwillberequiredtohavea recommendationformcompletedbyaboardadvisor.Youarestronglyencouragedtoincludethese sheetsorotherrecordsofyourboardactivitieswhenseekingyourrecommendation.Youcanemail, mailorfaxthissheettoAshleyMullens. BoardMemberName:____________________________________DateofEvent:_______________ LocationofEvent:________________________________Adulthelper:________________________ Roleofboardmember:_____________________________#ofyouthreached:__________________ Age/gradeofyouth:_____________#ofvolunteersinvolved:__________ EventDescription(Briefdescription,shouldgiveinformationonwhatyouthdid,howyouwereinvolved, whattheylearned): PersonalImpactstatement:(whatdidyougainfromthisevent):

Louisiana 4-H Overnight Event Permission/Health Form

(To be completed and signed prior to event. Participant MAY NOT register without a health form.)

[ATTACH PHOTO HERE]

**Please note that you will need a social security number for admittance to Rapides General Hospital in Alexandria.** Event or Activity _______________________________________ Name of Participant_____________________________________________Date of Birth_____________ First Middle Last Address______________________________________________________________________________ Street or PO Box City _______________________________State _____Zip Code____________Parish_______________ Parent/Guardian (for youth) Name: ________________________________________________________ Phone: Home_______________________Work_____________________Cell_____________________ Family Physician_______________________ Phone: Office_____________ Alternate_____________ Health Insurance Company Name & Address:________________________________________________ ________________________________________________ Group No._______________ Policy No._______________ Name of Insured:_______________________ Emergency Contacts: 1) Name:_________________________________________________________________________ Phone: Home____________________ Work _____________________Cell____________________ 2) Name:_________________________________________________________________________ Phone: Home____________________ Work _____________________Cell____________________ Health History: List all known drug allergies/allergies:_____________________________________________ Is there past or present history of the following? Check all that apply. Yes No Yes No Appendicitis ___ ___ Joint/back or limb pain ___ ___ Allergies/sinus problems ___ ___ Arthritis or other conditions ___ ___ Asthma/persistent cough ___ ___ Kidney or liver disease ___ ___ Bedwetting ___ ___ Menstrual problems ___ ___ Bleeding disorder ___ ___ Nervous condition/depression ___ ___ Convulsions/fainting ___ ___ Nose problems ___ ___ Diabetes/hypoglycemia ___ ___ Physical Disability ___ ___ Epilepsy/convulsion/fainting ___ ___ Poison ivy/oak/sumac rash ___ ___ Eye/ear problems ___ ___ Recent surgery/injury ___ ___ Frequent ear infections ___ ___ Serious illness ___ ___ Gall bladder problems ___ ___ Serious injury ___ ___ Heart defect/disease ___ ___ Skin/gland problems ___ ___ Hernia ___ ___ Sleepwalking ___ ___ Hypertension ___ ___ Stomach/bowel problems ___ ___ Hyperactivity/ADD/ADHD ___ ___ Tuberculosis ___ ___ Infectious disease ___ ___ Ulcers (stomach/intestines) ___ ___ Insect stings* ___ ___ Urinary problems ___ ___ *Localized redness/swelling do not constitute insect allergy. Body-wide rash, swelling, and difficulty breathing do constitute insect allergy (anaphylaxis).
Health Form Revised 04/12/2011

Explain any Yes items and list any other problems, including the diagnosis, date of injury or illness, hospital, length of hospitalization, name of doctor, etc. List any exposure to infectious disease in the two weeks prior to event._____________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ (Attach a page if extra space is needed for explanation) Immunizations (latest date): Tetanus________________ Hepatitis________________

Special or Prescription Medications: Please list any special medication being taken including the name and phone number of the prescribing physician, dosage, consumption rate and interval. Name of Medication Dosage Frequency Prescribing Physician & Number _____________________________ ______ ________ _____________________________________ _____________________________ ______ ________ _____________________________________ _____________________________ ______ ________ _____________________________________ _____________________________ ______ ________ _____________________________________ Special Restrictions: Chronic or recurring illness and treatment which may be needed __________________________ ______________________________________________________________________________ ______________________________________________________________________________ Dietary modifications require physicians written instructions be given to 4-H staff two (2) weeks prior to the event. Statement of Health: To my knowledge, I have no health problems, unless stated earlier, and can SAFELY PARTICIPATE in this event. I would rate my health as: (please circle one) POOR FAIR GOOD EXCELLENT. I have no contagious or communicable disease and have had no illness within 30 days that would preclude me from participating in this event. If I do have any health problems or illnesses, they are explained in the space provided on page one.

Insurance Information: LSU AgCenter insures all participants while they attend 4-H sponsored events. This insurance is limited to $3,000 and does not cover crutches. Remaining medical bills are the responsibility of the participant and his/her parent or guardian.

It is the policy of the Louisiana Cooperative Extension Service that no person shall be subjected to discrimination on the grounds of race, color, national origin, gender, religion, age, or disability.

Health Form

Revised 04/12/2011

Parent Permissions Page

PERMISSION FOR: ____________________________________________
Childs Name

Parent/Guardian Authorization for Medical Care:

I, the undersigned parent/guardian, understand that although the 4-H staff closely supervises the participants, the 4-H staff is not responsible in cases of accidental injury or illness. In the event first aid is necessary; it will be available on site. I give permission to the physician selected by the 4-H staff to order x-rays, routine tests and treatment for the health of my child, and in the event I cannot be reached in an emergency, I give permission to secure proper treatment for (hospitalize, order injections and/or anesthesia and/or surgery) my child.
I (parent) hereby give permission for Louisiana 4-H to administer the following over-the-counter medications if the nurse/med tech deems it necessary. Dosages will be administered according to directions on the bottle unless a parent or physician directs otherwise. Circle any item(s) you do NOT want administered to your child. Aleve Benzocaine swabs Ibuprofen Pamprin Antibiotic ointment Caladryl Lotion Laxative Sinus/Cold Medications Anti-diarrheal medicine Calamine Lotion Lip Balm Sunburn Lotion Antihistamine liquid or pill Eardrops Midol Swimmers Ear Drops Aspirin Eye Wash Milk of magnesia Throat spray or lozenges Bismuth subsalicylate Hydrocortisone cream Muscle Rub Tylenol (stomach relief liquid)

Parent/Guardian Authorization to participate or exclude participation in event activities:

I give permission for my child to participate in all event activities with the following exceptions: _________________________________________________________________________________________ Membership and participation in activities and events are open to all citizens without regard to race, color, nationality, origin, gender, religion, age, veteran status, or disability. If you have a disability that requires special accommodation for your participation in this event, please contact your parish 4-H agent two (2) weeks prior to your participation in this event. Indicate if your child has special requirements for travel/lodging or dietary needs due to disability or medical restrictions.________________________________________________________________________________ _________________________________________________________________________________________ For an optimum experience for your child and to safe guard all campers, please evaluate if your child should attend camp if they are exhibiting these symptoms: (List of symptoms including fever, lice, ring worms, etc.). For the health and welfare of all campers, if youre child exhibits these symptoms while at camp, you will be contacted to pick your child up from camp. Persons designated to take child from event:_________________________________________________ Persons not permitted to take child from event:_______________________________________________

Note: Your child may be photographed or videotaped for promotional or educational purposes. I understand my child may participate in and/or complete surveys and evaluations that will be used to determine 4-H program effectiveness or to promote the program. Youth will be asked their consent before completing a survey or evaluation. Participation in surveys and evaluations is voluntary and does not affect eligibility to participate in the 4-H program. I DO NOT agree to these terms. By my signature I am verifying that all the above information on the Louisiana 4-H Overnight Event Permission/Health Form is true and accurate. _________________________________________ Parent/Guardian
Parent Permissions Form

_________________________________________ Date
Revised 03/29/11

Code of Conduct for 4-H Events

Rules and regulations governing 4-H events will be discussed by agents and leaders with 4-Hers before the event. 4-Hers are under the supervision of all Extension personnel and other adults helping with the event. Each club member will be expected to participate fully in all programs and uphold exemplary standards of behavior. The following are grounds for sending 4-Hers home at their parents expense and may be grounds for suspension in district, regional and state events for up to 12 months. o Possession or use of illegal drugs, alcoholic beverages, tobacco products, pocket-hunting knives, fireworks or firearms. o Misuse or abuse of public or personal property. (Individuals responsible will also be required to pay for damages). o Disrespect for the authority of agents, leaders and specialists (such as failing to follow specific rules or instructions for the event or using abusive language). o Unauthorized absence from the premises of the event. o Unauthorized use of vehicles during the event. o Unauthorized possession of firearms and other weapons. o Breaking curfew or disturbing the peace (for example, being late for dormitory checks or disturbing others after lights out). o Unauthorized presence in room of a member of the opposite gender without permission of agent or leader. Realizing these guidelines are not all inclusive, the LSU AgCenter reserves the right to adjust these policies. Decisions on discipline will be the responsibility of the Extension agent(s) supervising the event in consultation with others designated as supervisors.

____________ Date

________________________________ Signature of 4-Her

_________________________________ Signature of Parent/Guardian

LouisianaState4HSETBoardContract
I,_________________________________,herebyagreetofulfillthedutiesoftheLouisiana4 HSETBoardasoutlinedbelow.IntheeventIamunabletomeettheseobligationsIunderstandthe State4HOfficeFacultyhastheoptionofremovingmefromtheboardfortheremainingportionof myterm. 1. IagreetopromoteLouisiana4HSETrelatedprojectsandtoassistwiththeplanningand promotionofstateeducationalprograms. 2. Iagreetorespondtoemails,lettersandphonecallsinatimelymannerinordertomaintain communicationwiththeboardandadvisors.Iunderstandthatcommunicationismyresponsibility andifatanytimeIloseaccesstoemailIwillnotifyappropriateboardpersons. 3. Iagreetoattendthesummerboardmeeting,participateintheservicelearningproject,completea parishprojectandcompletemyassigneddutiesasaSETboardmember. 4. Iagreetobecomecampcounselorcertified. 5. Iagreetocontinuetoserveasaleaderinmyparishandparticipateinparishactivities.Iagreeto planandconductaSETrelatedparishprojectandreportontheprojectbyApril1,2012. 6. IagreetoactasaliaisonbetweenthestateSETboardandtheregion/parishthatIrepresent. 7. IagreetoparticipateinSETboardactivities,National4HScienceDay,andboardcommitteesto thebestofmyability. 8. IagreetocompletetheProgramProposalandobtaintherequiredpermissionsbeforeplanningany eventasaSETboardmemberonbehalfof4H.Iunderstandthisincludeslocal,parish,regionaland stateevents. 9. Iagreetobeacurrentenrolledmemberin4Hatalltimesandanactivememberofalocalschool, projectorcommunityclub.IunderstandthattobeacurrentenrolledmemberImustcompleteand submitanenrollmentcardandpayenrollmentdues. 10. IfIvolunteertotakepictures/videoata4HeventIagreetocoordinatetheuseofthesepictures whetherifviawebsite,PowerPoint,CD,orothermeanswiththestaffofthatparticularevent. 11. Iagreetoberesponsible,selfstarting,dependable,anddedicatedtotheroleofworkingasateam member. 12. Iagreetohavetransportation/fundsformeetingsandcorrespondence. 13. IagreetoobeytherulesandproceduresofanyUniversitysystemthatIaccessinthecourseofmy duties. 14. Iagreetobeboundbyallofficialbylawsvotedonbytheboard. 15. Iagreetofollowallrulesoutlinedbythefederalstatueontheuseofthe4Hemblemandname, includingseekingpermissionbeforeusingtheLSUAgCentername/logoor4Hemblemonany writtenorelectroniccorrespondenceorwebsite. 16. Ihavefullyreadalltheinformationcontainedinthememberpacketandamawareofalldeadlines andexpectations.IunderstandIwillberesponsibleforkeepingupwithdeadlines. AsamemberandrepresentativeoftheLouisiana4HSETBoardandLouisiana4HYouthDevelopment program,Iwillalwaysseektoadvanceandpromote4Hwithhighethicalandmoralstandardsinall thatIdo.FurtherIwillstrivetolivebythesixpillarsofcharacter:trustworthiness,respect, responsibility,fairness,caringandcitizenship.Iagreetofollowalloftheaboveguidelinesandwillbe anactivememberoftheLouisianaState4HSETBoardforthedurationofmyterm. MemberSignature:____________________________________Date:____/_____/_____ Parent/GuardianSignature:__________________________________________________ PleasesubmitacopyofthisformtotheState4HOfficebyfaxormailbyJune15,2011.