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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Through 4-H I have learned so many things that can help me build my confidence. I went from feeling insecure about my disability to being able to tell other kids who have dyslexia that even if it is difficult, you shouldn\'t feel embarrassed about it. Since joining 4-H I can share my experience with dyslexia and help people understand the disability.

— Sophia Mason, Monroe 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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