CLUB SELF NOMINATION FOR COMMUNITY SERVANT AWARD

NEW IN 2015

The Wisconsin 4-H Community Servant Award recognizes one 4-H club/group per county annually who demonstrates exemplary service to their community. The Wisconsin 4-H Foundation provides this award to each county through the generous support of their donors. Nomination form due September 19th.

Self Nomination Form:

Club/Group Name:_____________________________________________________________

Individual (s) completing the nomination: __________________________________________

____________________________________________________________________________

Phone:____________________________ Email: _____________________________________

Award Selection Criteria:

Positive impact the club/group has had on the community

Club/group ongoing commitment to community service as evidenced by initiation or support of projects and activities in a way that promotes decision-making, problem solving, meeting challenges, mastery, and youth/adult partnerships

Exemplifying collaborative relationship building

Dedicated to a safe and inclusive environment in the community

Please answer the following questions on a separate piece of paper:

Briefly describe community service projects/activities your club/group completed during the past year, indicate whether the projects were new this year or repeated/continued from previous years.

What was the impact on the community from your service projects?

How does the club decide on community service projects/activities each year?

What skills were demonstrated or learned by the members helping with the community service?

Explain new or existing relationships that were critical to carrying out the service projects.