Congratulations on your selection as a 4-H Emerald Clover Society inductee! Although your nomination included important biographical information, we would like to also request the information below to ensure that we have the most complete profile of your career, community and personal accomplishments. Once again, congratulations from Michigan 4-H on receiving this prestigious honor!Name(Required) First Last Title/HonorificDr., Mr., Mrs., Ms., Mx., Rev., The Honorable, etc. PronounsShe/her/hers He/him/his They/them/theirs, etc. Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone(Required)Email(Required) County of current residence(Required) Total years of 4-H membership(Required) List name(s) of your 4-H clubs, county/counties and the name(s) of 4-H volunteer leaders for the Michigan 4-H club(s) in which were were a youth member.Name of 4-H Club County of 4-H Club Name of 4-H Club Volunteer Leader(s) Name of 4-H Club 2 County of 4-H Club 2 Name of 4-H Club Volunteer Leader(s) 2 Name of 4-H Club 3 County of 4-H Club 3 Name of 4-H Club Volunteer Leader(s) 3 Name of 4-H Club 4 County of 4-H Club 4 Name of 4-H Club Volunteer Leader(s) 4 3. List any significant awards or achievements as a 4-H member and/or professional career:4. Please list significant community service and/or philanthropic support:5. Please share how you believe your 4-H involvement contributed to your professional and personal success:(Required)Resume or CV(Required)Although your nomination included important biographical information, we would like to also request a copy of your most current resume or vita to ensure that we have the most complete profile of your career, community and personal accomplishments. Please upload your resume or vita.Max. file size: 100 MB.Photo SubmissionPlease upload a high resolution digital portrait photo. For questions or if your photo is too large to upload, please email jmwilson@msu.edu.Max. file size: 100 MB.Media Release(Required)I authorize Michigan State University and/or the Michigan 4-H Foundation to use my image, biography and/or statements submitted as part of the Michigan 4-H Emerald Clover Society recognition. I give Michigan State University and/or the Michigan 4-H Foundation all rights to use of these images and words. I understand that said images, biography elements and/or statements will be used for educational, advertising and promotional purposes in conventional and electronic media, including but not limited to the Internet, and any future media. I also authorize the use of any printed material in connection therewith. I understand and agree that these images and words may be duplicated, distributed with or without charge, and/or altered in any form or manner without future or further compensation or liability, in perpetuity. Yes, I approve the media release. No, I do not approve the media release. 4-H Legacy Awards Guest ListYou may invite additional people to the 4-H Legacy Awards Ceremony on Sept. 21, 2024 where you will be honored. Please provide names and addresses (full name(s), address, city, state, ZIP and email, if applicable). Advanced Reservations Invitations for the 4-H Legacy Awards Celebration on Sat., Sept. 21, 2024 will be mailed and emailed later this summer. However, as an honoree, you may register in advance. To register now, visit: https://mi4hfdtn.org/legacy-awards/. We look forward to seeing you on Sept. 21!
