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CongratulationsonbeingselectedtoserveontheState4HScience,EngineeringandTechnologyBoard.
ItisanhonortobeselectedontheSETBoard,butitisalsoabigresponsibility. Asweembarkona
successfulyear,itwilltakecommitmentandeffortoneveryonespart. Throughoutthisyearwewillworktowardsexcellenceinleadershipandteamwork.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:[email protected]
Mail:AshleyMullens,POBox25100,BatonRouge,LA70809
Pleasenotethatformsshouldbemailedatleast35daysPRIORtotheduedate.
Packet
Contents
SETBoardContractSignatureofthisformsignifiesacceptanceofposition.ThiscontractshouldbesignedandreturnednolaterthanJune15,2011.
OfficerPositionsandApplications Ifapplying,applicationmustbesubmittednolaterthanJune15,2011.Emailpreferred.BeinganofficerisagreatwaytocontributetothesuccessoftheSET
boardandtoensureameaningfulexperienceforyourself.SETboardofficerswillbeinvitedto
participateintheSouthernRegionTeenLeadershipConference(Oct.1316,2011)andthe
Governorsdinner(June5,2012).
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HealthFormandCodeofConductTheseformswillbedueforeacheventyouattendasaSETboardmember.Itisrecommendedthatyoukeepafewcopiesreadytogo.Acopyofthese
formsisdueJune15forthesummerboardmeeting.
ParishProjectInformation EventsandImportantDates
2011
2012
Board
Advisors
AshleyMullens,StateOffice
2255782196
AllpaperworkandquestionsregardingpaperworkshouldbesenttoAshleyMullens.KatinaHester,AscensionParish
[email protected](preferred)
5306437837textcapable
DavidBoldt,StateOffice
2255782196
RubyMiller,CameronParish
3373919552textcapable
JoannaStrong,RichlandParish
[email protected](preferred)
3187283216
3182826273(textcapable)
CynthiaPierfax,EastCarrollParish
3185591459
AlexShook,BossierParish
3189652326
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SETBoardActivitiesandDueDates
Itistheresponsibilityofeachboardmembertoknowthedatesbelow.Remindersofupcomingdue
datesandpaperworkneededarenotguaranteed.Pleaseplacethesedatesonyourcalendarforthe
upcomingyear.
CopiesofthisandadditionalannouncementswillbepostedtotheSETboardFacebookgroup.Ifyoudo
nothaveaccesstoFacebookpleaseletusknow.
Pleasenotethatofficerswillbegivenanadditionallistofduedatesrelatedtotheirpositionupon
election.
Anyformsdueduringtheyearshouldbefaxed,emailedormailedtothefollowingaddress(unless
indicatedotherwise):
FaxNumber:2255787847
Email:[email protected]
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.ItemsinBoldarerequiredboardactivities.
2011
June15
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o SETBoardContract,HealthForm,CodeofConductandmembershipfeedue.Membershipfeemustbecheck/moneyordermadeouttoLouisiana4HFoundation.
o Officerapplicationsdue. June16
o CopiesofofficerapplicationswillbepostedtotheSETBoardFacebookgroupforallboardmembersforreview.
June21o SETBoardBusinessmeeting.PresidentandVicePresidentwillbeelected.Membersmissingthemeetingareresponsibleforcommunicatingwithboardpresidenttogetany
importantinformation.1:303pm,CastilianRoom(LSUUnion).
July1o SummerboardmeetingagendawillbepostedtoFacebookgroup.
July68o SETboardleadershipretreatandsummerboardmeeting(Woodworth,LA).TransportationpickupwillbeprovidedfromBatonRouge,LAandLafayette,LA.
Membersmissingmeetingwillbedismissed.Therearenoexcusesallowed.Ifamember
missesthemeetingduetoafamilyemergencytheywillstillbedismissedbutwillbe
eligibletoapplythefollowingyear.
o HealthformandcodeofconductforLOSTcampdueatmeeting.o WorldsFinestChocolatecheckdueforchocolatepickupatLOSTcamporOMKCamp.
July31 August5o LOSTcamp.BoardmemberswillarriveatCampGrantWalkerSunday,July31by5p.m.CampersarriveAugust1.
o OfficersRetreat.OfficersshouldarriveSundaymorningby10amforanofficersleadershipretreat.
Aug.17o HealthformandcodeofconductdueforOMKSETCamp.
Aug.2628o OMKSETcamp.o FinaldetailsforboardServiceLearningprojectwillbegivenoutandpostedtoFacebook.
DATETBA(Fall2011)o ServiceLearningProject
Octobero National4HScienceExperiment.Makeplanswithparishtohelphostexperimentatparishand/orclubevent(s).Greatparishproject!
Oct.21o Ifattending4Htailgatesubmithealthform,codeofconductandtailgateattendanceform.
o Quarterlyreportdue.IncludeNational4HScienceDayactivities,JulyOctactivitiesyoudidalongwithnumberofyouth,date,location,etc
o Heathformandcodeofconductdueforroboticstournament. November12.
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o 4HFootballgame.Boardmembershavetheopportunitytowalkonthefieldatpregame.
o SubmitsignedProgramPlanningSheetforparishprojectifyouhaventalreadyconductedtheevent.
November DateTBA.o CentralRegionFirstLegoLeagueTournament.
Dec.15o Healthform,codeofconductandattendanceformforWinterBoardMeetingdue.o WorldsFinestChocolatecheckdueforchocolatepickupatWinterBoardMeeting.
2012
Jan.67o WinterboardmeetingatCampGrantWalker.Boardmembersarriveby5pmFriday.Depart11amSunday.Transportationshouldbearrangedbyboardmembers(check
withparishorothermembers).
o Quarterlyreportdue,includeOctoberDecemberactivities.March
1
o LOSTCampLessonplanfirstdraftduetoadvisorsandLOSTcampcoordinator April1
o ParishprojectarticleandphotoduetoKatinaHesteratkhester@agcenter.lsu.edu.o Quarterlyreportdue,includeJanMarchactivities.
April15o FinaldraftlessonplansandbudgetdueforLOSTcamp.Budgetandfinallessonplanwillbereviewedandrevisionrequestssentout.Committeereportsdue.
May30o FinalLOSTCampLessonplansandbudgetdue.Lessonactivitiesshouldbecompletelytestedbythisdate.
June15o FinalQuarterlyReportDue,coveractivitiesfromAprilJune.
DescriptionofEventsSummerBoardMeetingThismeetingistheintroductorymeetingfortheboard.Boardmemberswill
participateinteambuildingactivities,leadershiptrainingandprepareforupcomingeventsincluding
LOSTcamp,OMKSETcampandservicelearningproject.
LOSTCampThisistheSETcampfor7th
&8th
graders.TheSETboardplaysalargeroleinLOSTcampby
sponsoringandleadingeducationaltracksandeveningassemblies.Theboardwillalsosetthetheme
andplananyspecialactivities.
OMKSETCampTheSETboardhoststheOMKSETcamp.Thiscampisformilitaryyouthages518.
Duringthiscamptheboardwillalsohaveanopportunitytohostashortmeeting.
4HFootballGame/DaywithTigersBoardmemberswillwalkontoTigerfieldduringhalftimeandwill
helpwithactivitiesandboothsatthetailgatepriortothegame.
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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.
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20112012OfficerPositions
Ifyouareinterestedinapplyingforoneoftheavailableofficerpositions,pleasereadthislettercarefully.Any
memberiseligibletorunforoffice.BoardmembersrunningforPresidentorVicePresidentMUSTbepresentatthe
4HUniversitybusinessmeeting.ThebusinessmeetingwillbeheldTuesday,June21from1:303:00p.m.
Toapply,completetheappropriateapplicationandmail,fax,oremailtothe4HStateOfficebyJune15.Youmayapplyformultiplepositions,butmustfilloutaseparateapplicationforeach.ApplicationMUSTbelegible(typeor
printinink)oritwillnotbeconsidered.Applicationswillbemadeavailabletoallboardmemberspriortoelections.
ThePresident,VicePresident,Secretary,ReporterandSr.CampCoordinatorwillbeinvitedtoattendtheSouthern
RegionTeenLeadershipConferenceOctober1316,2011inCrossville,TN.Allofficerswillbeinvitedtoattendthe
GovernorsdinnerinJune2012dependentonspotsavailable.Iftherearenotenoughspotsforallofficers,seatswill
bebasedonseniority(gradelevel). OfficialboardmeetingsmentionedbelowincludeSummerBoardMeetingand
WinterBoardMeeting.Additionalmeetingsmaybeadded.
Positions AvailablePresidentThePresidentwillserveastheleaderfortheboard.Presidentwillworkwithboardadvisorstosetmeetingagendas
andleadallboardmeetings.Presidentwillberesponsibleforboardcommunications.Mustattendallofficialboard
meetings.MUSThaveandcheckemailregularly.Mustbeenteringyourjuniororsenioryear.Presidentwillalsobe
askedtogiveaspeechattheGovernorsdinnerandmaybeaskedtorepresenttheboardatotherpublicfunctions.
VicePresidentTheVicePresidentwillhelpthePresidentwithleadershipoftheboard.VicePresidentwillberesponsiblefor
planningandcoordinatingtheboardservicelearningproject.MUSThaveandcheckemailregularly.VicePresident
willbeexpectedtocompleteaservicelearningcourseandbecommittedtoprovidingaqualityserviceexperience
fortheboard.
SecretaryThesecretarywillbetakeminutesatallmeetingandsubmitminutestotheboardmember.Minutesmustbe
submittedwithintwoweeksoftheevent.Mustattendallofficialboardmeetings.
ReporterReporterwillberesponsibleforwriting/coordinatinganewsstoryonallofficialboardeventsincludingLOSTcamp,
OMKSETcamp,National4HScienceexperiment,4HTailgate,andtheservicelearningproject.Reportermayneed
totakephotographsofeventsforstoriesalso.
LOSTCampCoordinatorThisisa2yearpositionandcommitment.SeniorLOSTCampCoordinatorwillberesponsibleforleadingplanningfor
eveningassemblies.JuniorLOSTCampCoordinatorwillberesponsibleforleadingtrackplanning.Mustattendall
officialboardmeetings.
RegionalRepresentativeNumberofpositionsperregionwillbedeterminedbymembershipnumbers.Theregionalrepresentativewillbe
responsibleforcommunicatingwithboardmembersintheirregion.Theregionalrepwillworkwiththe4HRegional
Coordinatortoidentifyopportunitiesforboardmemberleadership.Regionalrepswillberesponsiblefor
writing/collectinganarticleforeacheditionoftheboardnewsletter.
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PresidentApplicationForm
Name:____________________________________ Parish:____________________________
Grade:________ Yearsin4H:______ Email:____________________________
Answerthefollowingquestionsonaseparatesheetofpaper.Pleasetypeandemailifpossible.1) OfficerPositionsHeld:2) Pleasedescribeindetailanexamplewhereyouwereresponsibleforleadingagrouporteam.Talkabout
methodsusedtocommunicateandmotivate.
3) Tellusyourvisionforleadershipoftheboard.Bespecificingoalsyouwouldliketoaccomplishandhowyouwouldimplementthegoals.
4) Characterisanimportantpartofbeingagoodleader.Writeabriefparagraphdiscussingthetraitsofgoodcharacterandwhycharacterisimportantasaleader.
5) TelluswhyyouthinkyouwouldyouwouldmakeagoodPresident.6) Whatdoyouthinkisthebestwaytocommunicatewithboardmembers?Ifpossible,pleasehaveyour4Hagentemailorfaxaletterorstatementofrecommendationforyouinthis
position.
VicePresidentApplicationForm
Name:____________________________________ Parish:____________________________
Grade:________ Yearsin4H:______ Email:____________________________
Answerthefollowingquestionsonaseparatesheetofpaper.Pleasetypeandemailifpossible.1) OfficerPositionsHeld:2) Pleasedescribeindetailanexamplewhereyouwereresponsibleforleadingaservicelearningproject.Talk
aboutmethodsusedtoorganizeandmanagetheproject.
3)Describe
a
possible
service
learning
project
you
would
do
with
the
SET
board
and
give
details
on
how
you
wouldimplementtheproject.
4) TelluswhyyouthinkyouwouldyouwouldmakeagoodVicePresident.Ifpossible,pleasehaveyour4Hagentemailorfaxaletterorstatementofrecommendationforyouinthis
position.
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ReporterApplicationForm
Name:____________________________________ Parish:____________________________
Grade:________ Yearsin4H:______ Email:____________________________
Answerthefollowingquestionsonaseparatesheetofpaper.Pleasetypeandemailifpossible.1) Haveyouservedasareporterforanorganizationbefore?Ifyes,listposition,organizationandyear.2) AreyoucurrentlyorhaveyoupreviouslyenrolledintheCommunicationorBroadcastandPrintJournalism
projects?Describewhatyoulearnedorlistotherexperiences/projectsthathavecontributedtoyourskillsas
areporter.
3) Submitanexamplestory.Inthespacebelowtellusaboutwhatmethodsyouusedtowriteyourstoryincluding:anyinterviewsobtained,howyouobtainedyourstoryinformationandwhathappenedtothe
storyafterwards.
4) TelluswhyyouthinkyouwouldmakeagoodreporterfortheSETBoard?Ifpossible,pleasehaveyour4Hagentemailorfaxaletterorstatementofrecommendationforyouinthis
position.
SecretaryApplicationForm
Name:____________________________________ Parish:____________________________
Grade:________ Yearsin4H:______ Email:____________________________
Answerthefollowingquestionsonaseparatesheetofpaper.Pleasetypeandemailifpossible.1) Haveyouservedasasecretaryforanorganizationbefore?Ifyes,listposition,organizationandyear.2) Areyoucurrentlyorhaveyoupreviouslyenrolledinaprojectbookrelatedtothepositionofsecretaryor
treasurer?
Describe
what
projects
and
what
you
learned.
3) Telluswhyyouthinkyouwouldmakeagoodsecretary/treasurerfortheSETBoard?
Ifpossible,pleasehaveyour4Hagentemailorfaxaletterorstatementofrecommendationforyouinthisposition.
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LOSTCampCoordinatorApplication
Name:____________________________________ Parish:____________________________
Grade:________ Yearsin4H:______ Email:____________________________
Answerthefollowingquestionsonaseparatesheetofpaper.Pleasetypeandemailifpossible.1) LeadershipPositionsheld(juniorleaders,clubpresident,eventchair):2) Describeanevent,workshoporlessonyouwereresponsibleforplanning.Talkaboutwhatyoudidtoplan,
organizeandcommunicate.Talkaboutanycreativeideasyoucameupwith.Pleasebeverydetailedwithall
partsoftheplanningandimplementationoftheevent.
3) Giveanexamplewhereyouleadateamandhadtomeetdeadlines.Describemethodsusedtoplanandmotivate.
4) TelluswhyyouthinkyouwouldmakeagoodLOSTCampCoordinator.
Haveyoubeento4Hcamp? Yes No
Haveyouservedasacampcounselor?YesNo
AreyouCampCounselortrained?YesNo
Canyoucommitto2yearsofattendingLOSTcampandservinginthisposition?YesNo
Ifpossible,pleasehaveyour4Hagentemailorfaxaletterorstatementofrecommendationforyouinthisposition.
RegionalRepresentative
Name:____________________________________ Parish:____________________________
Grade:________ Yearsin4H:______ Email:____________________________
Answerthefollowingquestionsonaseparatesheetofpaper.Pleasetypeandemailifpossible.1) Howoftendoyoucheckemail?Whatdoyouthinkisthebestwaytocommunicatewithboardmembers?2) Describeapossibleleadershipopportunitymembersinyourregioncouldparticipateinorimplement.3) Listactivitiesyouhavedonewithinthepastyearonaparishorregionallevel.4) Whydoyouthinkyouwouldmakeagoodregionalrepresentative?
Ifpossible,pleasehaveyour4Hagentemailorfaxaletterorstatementofrecommendationforyouinthisposition.
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ParishProjectInformationBeinganactiveleaderonalocallevelisanimportantpartofbeingaStateSETboardmember.Allboard
membersmustcompletetheProgramProposal(Seeprogramproposalsheetguidelines)fortheirparish
project
by
November
12
th
.
Each
member
is
REQUIRED
to
complete
a
parish
project
and
turn
in
an
article
withphotonolaterthanApril1,2012.Aparishprojectiseventsoractivitiesinwhichyoutakea
leadershiprole.Aparishprojectshouldmeetatleast10youthandbeatleast12hoursinlengthtotal.
Thiscouldbethrough1singleeventormultiple.Ideascouldinclude(butnotlimitedto):
SETorSETrelatedprojectclub Conductingaworkshoporminicamp RunningSETrelatedcontest ConductingtheNationalScienceExperimentinyourparishwithdifferentgroups Helping4Hmemberswiththeirprojects(SETrelated)
ItisstronglyencouragedthatyouNOTplanyourparishprojectforthemonthofMarchasthisisan
extremelybusytimeofyearinmostparishes.Begintalkingtoyouragentasearlyaspossibleinthefall
aboutyourparishprojectandideas.
WriteUpRequirementsYourwriteupmustbeatleast2paragraphsinlength(nolessthan12sentences)andshouldcoverthe
followingdetails:
Dateofevent Locationofevent Titleofevent Numberofkidsinattendance Detailsoftheactivity(whatyoudid,whatthekidslearned,howitrelatestoSETand4H) Aquotefromaparticipantabouthowtheeventaffectedthem Aphoto Aquotefromyouaboutyourexperience
Boardmemberswhodonotcompletethisrequirementwillbeineligibletoapplyfora2nd
term.Ifthe
boardmemberhasalreadymissedanotherrequiredactivity(summerboardmeeting,servicelearning
project,boardmemberduty)thentheywillbedismissed.
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EventProposalOutlineforStateBoardMembersSuggestionsforeventsshouldincludealltheinformationrequestedbelow.Proposalswillbeevaluated
byyourparish4HYouthDevelopmentAgent,4HRegionalCoordinator(ifproposingaregionalevent),
andyourStateBoardSponsor.Allpartiesmustapprovetheeventbeforetheplanningprocessbegins.
Pleaselimitthetotalproposaltonomorethantwo(2)pages.
Team:o Pleaselistallmembers(bothYouthandAdults)thatwillserveontheeventplanning
committee.
EventDescription:o Includeabriefdescriptionofprogram/activitythatyourteamwantstoputintoaction.
NeedsBase:o Howwastheneedforthiseventidentified?o Whatwillthiseventaccomplish?
EventOutline:o WhatWillBeDone?o ByWho?o When?o Where?
Funding:o WhatdoyoupredicttheEventcosting?o Aretheresponsorsthatwouldbeinterestedinsupportingthisevent?o Whereisthemoneytobekept?
Agentssignature:___________________________
RegionalCoordinatorsSignature(ifrelevant)*:___________________________
BoardSponsorsSignature*:___________________________
*Approvalcanbegrantedviaemail
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EventReflectionSheet
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):
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Health Form Revised 04/12/2011
Louisiana 4-H Overnight Event Permission/Health Form(To be completed and signed prior to event.
Participant MAY NOT register without a health form.)
**Please note that you will need a social security number for admittanceto 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, anddifficulty breathing do constitute insect allergy (anaphylaxis).
[ATTACHPHOTOHERE]
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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 twoweeks 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 prescribingphysician, 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 inthis 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 precludeme from participating in this event. If I do have any health problems or illnesses, they are explained inthe space provided on page one.
Insurance Information:LSU AgCenter insures all participants while they attend 4-H sponsored events. This insurance islimited to $3,000 and does not cover crutches. Remaining medical bills are the responsibility ofthe 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.
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Parent Permissions Form Revised 03/29/11
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.
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 specialaccommodation 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.
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 Date
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.
AleveAntibiotic ointment
Anti-diarrheal medicine
Antihistamine liquid or pill
Aspirin
Bismuth subsalicylate
(stomach relief liquid)
Benzocaine swabsCaladryl Lotion
Calamine Lotion
Eardrops
Eye Wash
Hydrocortisone cream
IbuprofenLaxative
Lip Balm
Midol
Milk of magnesia
Muscle Rub
PamprinSinus/Cold Medications
Sunburn Lotion
Swimmers Ear Drops
Throat spray or lozenges
Tylenol
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.
8/6/2019 2011 SET Board Member Packet
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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 payfor damages).
o Disrespect for the authority of agents, leaders and specialists (such as failing to follow specific rulesor 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 orleader.
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
8/6/2019 2011 SET Board Member Packet
18/18
1
LouisianaState4HSETBoardContract
I,_________________________________, herebyagreetofulfillthedutiesoftheLouisiana4
HSETBoardasoutlinedbelow. IntheeventIamunabletomeettheseobligationsIunderstandthe
State4HOfficeFacultyhastheoptionofremovingmefromtheboardfortheremainingportionof
myterm.
1. IagreetopromoteLouisiana4HSETrelatedprojectsandtoassistwiththeplanningandpromotionofstateeducationalprograms.
2. Iagreetorespondtoemails,lettersandphonecallsinatimelymannerinordertomaintaincommunicationwiththeboardandadvisors.Iunderstandthatcommunicationismyresponsibility
andifatanytimeIloseaccesstoemailIwillnotifyappropriateboardpersons.
3. Iagreetoattendthesummerboardmeeting,participateintheservicelearningproject,completeaparishprojectandcompletemyassigneddutiesasaSETboardmember.
4. Iagreetobecomecampcounselorcertified.5. Iagreetocontinuetoserveasaleaderinmyparishandparticipateinparishactivities.Iagreeto
planandconductaSETrelatedparishprojectandreportontheprojectbyApril1,2012.
6. IagreetoactasaliaisonbetweenthestateSETboardandtheregion/parishthatIrepresent.7. IagreetoparticipateinSETboardactivities,National4HScienceDay,andboardcommitteesto
thebestofmyability.
8. IagreetocompletetheProgramProposalandobtaintherequiredpermissionsbeforeplanninganyeventasaSETboardmemberonbehalfof4H.Iunderstandthisincludeslocal,parish,regionaland
stateevents.
9. Iagreetobeacurrentenrolledmemberin4Hatalltimesandanactivememberofalocalschool,projectorcommunityclub.IunderstandthattobeacurrentenrolledmemberImustcompleteand
submitanenrollmentcardandpayenrollmentdues.
10. IfIvolunteertotakepictures/videoata4HeventIagreetocoordinatetheuseofthesepictureswhetherifviawebsite,PowerPoint,CD,orothermeanswiththestaffofthatparticularevent.
11. Iagreetoberesponsible,selfstarting,dependable,anddedicatedtotheroleofworkingasateammember.
12. Iagreetohavetransportation/fundsformeetingsandcorrespondence.13. IagreetoobeytherulesandproceduresofanyUniversitysystemthatIaccessinthecourseofmy
duties.
14. Iagreetobeboundbyallofficialbylawsvotedonbytheboard.15. Iagreetofollowallrulesoutlinedbythefederalstatueontheuseofthe4Hemblemandname,
includingseekingpermissionbeforeusingtheLSUAgCentername/logoor4Hemblemonany
writtenorelectroniccorrespondenceorwebsite.
16. Ihavefullyreadalltheinformationcontainedinthememberpacketandamawareofalldeadlinesandexpectations.IunderstandIwillberesponsibleforkeepingupwithdeadlines.
AsamemberandrepresentativeoftheLouisiana4HSETBoardandLouisiana4HYouthDevelopment
program,Iwillalwaysseektoadvanceandpromote4Hwithhighethicalandmoralstandardsinall
thatIdo.FurtherIwillstrivetolivebythesixpillarsofcharacter:trustworthiness,respect,
responsibility,fairness,caringandcitizenship.Iagreetofollowalloftheaboveguidelinesandwillbe
anactivememberoftheLouisianaState4HSETBoardforthedurationofmyterm.
MemberSignature:____________________________________ Date:____/_____/_____
Parent/GuardianSignature:__________________________________________________
PleasesubmitacopyofthisformtotheState4HOfficebyfaxormailbyJune15,2011.