2011 set board member packet

8/6/2019 2011 SET Board Member Packet

1/18

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).


2/18

HealthFormandCodeofConductTheseformswillbedueforeacheventyouattendasaSETboardmember.Itisrecommendedthatyoukeepafewcopiesreadytogo.Acopyofthese

formsisdueJune15forthesummerboardmeeting.

ParishProjectInformation EventsandImportantDates

2011

2012

Board

Advisors

AshleyMullens,StateOffice

[email protected]

2255782196

AllpaperworkandquestionsregardingpaperworkshouldbesenttoAshleyMullens.KatinaHester,AscensionParish

[email protected](preferred)

5306437837textcapable

DavidBoldt,StateOffice

[email protected]

2255782196

RubyMiller,CameronParish

[email protected]

3373919552textcapable

JoannaStrong,RichlandParish

[email protected](preferred)

3187283216

3182826273(textcapable)

CynthiaPierfax,EastCarrollParish

[email protected]

3185591459

AlexShook,BossierParish

[email protected]

3189652326


3/18

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


4/18

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.


5/18

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.


6/18

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.


7/18

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.


8/18

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:____________________________


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.


9/18

ReporterApplicationForm

Name:____________________________________ Parish:____________________________


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:____________________________


Answerthefollowingquestionsonaseparatesheetofpaper.Pleasetypeandemailifpossible.1) Haveyouservedasasecretaryforanorganizationbefore?Ifyes,listposition,organizationandyear.2) Areyoucurrentlyorhaveyoupreviouslyenrolledinaprojectbookrelatedtothepositionofsecretaryor

treasurer?

Describe

what

projects

and

what

you

learned.

3) Telluswhyyouthinkyouwouldmakeagoodsecretary/treasurerfortheSETBoard?

Ifpossible,pleasehaveyour4Hagentemailorfaxaletterorstatementofrecommendationforyouinthisposition.


10/18

LOSTCampCoordinatorApplication

Name:____________________________________ Parish:____________________________


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


RegionalRepresentative

Name:____________________________________ Parish:____________________________


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



11/18

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.


12/18

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


13/18

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):


14/18

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]


15/18

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.


16/18

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.


17/18

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


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.

2011 set board member packet

Documents