(Eligibility: currently active leader who has served a minimum of 5 years. Nomination due in 4-H office by May 1 in order to be considered for the current program year) Please use additional pages when necessary.
If you wish, you may fill out this form and then print it. However it must be mailed to our County Program Rep.
Please mail the completed form to
UCCE 4-H
Rachel Taylor
1045 Arlington Dr
Costa Mesa Ca 92626