Horizon
Leadership Program Application
Grange
Name: ___________________________________________ Grange No._____________________
Last
Name: _______________________________________ First Name:___________________________
Mailing Address: ________________________________________________________________________
City: ___________________________________ State: ___________________ Zip Code:
_____________
Phone
Number: _______________________________ Email: ___________________________________
Youth Ambassador: __________
Birth
Date: __________________________________ Male: ______________ Femal: ________________
Parents
Names: ________________________________________________________________________
Give
a brief description of your occupation or grade with name of school
_______________________________________________________________________________________
Date
of Joining Grange ___________________ Highest Degree held _____________
Number
of members in Subordinate Grange ______ Average number of members at meetings
_________ Number
of Grange meetings held in the last year _______ Number
of Grange meetings you attended this last year _____ What activities and events did your state require you to participate in as an ambassador?
______________________________________________________________________________________
______________________________________________________________________________________
Your
current offices or committee assignments _______________________________________________
______________________________________________________________________________________
List three achievement awards or star awards you have earned this year or are currently working
on:
1 _____________________________________________________________________________________
2
_____________________________________________________________________________________
3 _____________________________________________________________________________________
Your
Signature _________________________________________________________________________
Subordinate
Certification: This will certify that the above named person is an active member
in good standing of our Grange, and is eligible to participate in this program,
and that the information contained in this report is correct.
Subordinate
Youth Chairman or Secretary Signature
______________________________________________________ Date __________________
Master's Signature ______________________________________________ Date __________________
State
Certification: Youth
Director's Signature ________________________________________ Date _________________
State
Master's Signature _________________________________________ Date__________________
Two letters of recommendation are to be sent in additio to this application:
- Subordinate Grange, preferably Mastor or Secretary
- State Master
A
maximum of one additional page for each topic may be added for the following topics:
(Maximum of 5 additional pages!)
A.
Fellowship Activities, Fun: List the activities
that you participated in that promoted fellowship, and fun. Please include all
your Grange activities any other community club and church activities.
B.
Recognition: Please tell us about the recognition
you have received in the Grange, School, and other organizations. C.
Leadership: How have you served as a leader
in your local Grange, Pomona Grange, State Grange, other organizations and school?
D.
Service: List the service activities, mentoring
opportunities, and projects you have been involved in, in your community, Grange,
State and nation. E.
Membership: What have you done to promote
membership in the Grange? How many people have you encouraged to join the Grange?
How many actually joined?
This
form is due to the National Grange Youth Development Director on or before September
10th. Send forms to National Grange Youth Development Director, Cindy Greer, 7629
C.R.100, Hesperus, CO 81326 |
