Emerald Clover Nomination Form

Nomination Deadline: March 15, 2026

Emerald Clover Nomination Form

Nominee’s name*
County of 4-H membership*
Years of 4-H membership*
to*
(Note: Three years of documented Michigan 4-H membership is required in order for nominee to be considered.)
Nominee’s most recent profession*
Nominee’s current mailing address:
(Note: This is required in order for a nominee to be considered. Nominees must be living and we must be able to contact them if they are chosen to receive this honor.)
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email*
Phone
Evidence of professional/business achievement and success
1. Leader in their professional field and/or evidence of academic leadership and success in their area of professional or business study if nominee is a college student or young professional.*
(5 points)
2. Innovation in their professional field.*
(5 points)
3. Local, state or national leadership, elected position or professional accomplishments recognized by others.*
(5 points)
Evidence of community service/philanthropy leadership
4. Leader, chair, head of a major community service or philanthropic initiative.*
(5 points)
5. Donor or contributor whose gifts have made a recognized and significant impact on a community.*
(5 points)
6. City, county, state, national awards and honors for community service and/or philanthropy.*
(5 points)
Evidence of leadership in community, state and national affairs
7. Community service, civic engagement and/or philanthropic impact that improves the way people in your local community or within Michigan lives.*
(5 points)
8. Community service, civic engagement and/or philanthropic impact that improves the way Americans live, regardless of who they are or where they reside.*
(5 points)
Evidence of leadership or achievement as a 4-H member/volunteer
9. Success as a 4-H member:*
List awards, recognition, leadership and achievements: (5 points)
10. Evidence of success as a teen or adult 4-H volunteer:*
List awards, recognition, leadership and achievements. (5 points)
Who might also be contacted to share information about why this person should receive this recognition?
Peer or Colleague*
Phone
Other
Phone
Nominated by
Nominator Phone
Nominator Email*
Mailing Address
This information is requested so that we may provide notify you on the outcome of your nomination. Thank you.
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Because of 4-H, I get to travel to places I may not otherwise visit. In our travel club, we visit different places, see new sites, experience different ways to travel, and learn about new cultures. Because of 4-H, I got a passport!

— Lauren Eichhorn, Menominee County

Emerald Clover Nomination Form

Nomination Deadline: March 15, 2026

Emerald Clover Nomination Form

Evidence of professional/business achievement and success

Evidence of community service/philanthropy leadership

Evidence of leadership in community, state and national affairs

Evidence of leadership or achievement as a 4-H member/volunteer

More in this Section

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