Deadline: June 23, 2017

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*To fill out form and submit, you must use Internet Explorer -OR- save the form and open with Adobe Acrobat Reader* NAME_________________________________________________________________ ADDRESS______________________________________________________________ PHONE_________________ CLUB_________________________________________________________________ GRADE (entering in the fall)____________

NUMBER OF YEARS IN 4-H_____________

NUMBER OF YEARS AS A JUNIOR SUPERINTENDENT_______________ Please number your preferences on where you want to work: (1st, 2nd, 3rd choice) Small Animal Barn ________ Youth Building ____________ Both ___________

List any FAIR experiences (both county and state).

List the skills you have that will help you do this job well. (example: public speaking, working with others as a team, animal science or other project area, etc.)

Do you have any other commitments during Fair week we need to work around your schedule? (example: public presentations, animal shows, family vacations, etc.)

PLEASE RETURN THIS FORM TO: Cornell Cooperative Extension, 4-H Office, 5274 Outer Stowe Street, Lowville, New York 13367

Deadline: June 23, 2017