PURDUE COOPERATIVE EXTENSION SERVICE College of Agriculture Dear Future Entrepreneur, Are you ready to create the next great Indiana business? Come join other young entrepreneurs like yourself at the Indiana 4-H Entrepreneurship Academy! Who: Indiana youth currently in high school (9 th -12 th ); individuals or in teams of no more than four Space is limited to 30 participants. Indiana 4-H membership is not required. When: June 13-15, 2018 Where: Purdue University, West Lafayette Cost: $190 How: 1. Write a 300-word essay that addresses: Why you want to attend the Entrepreneurship Academy, what you hope to learn by attending, and an example of a time when you've successfully or unsuccessfully worked in a team. Submit this essay with your application. 2. Complete the enclosed application (pages 2-5). 3. Submit the essay, application and registration fee of $190. (If you have a team, all team members must register, complete the essay, and pay the registration fee.) Alternately, you may complete all of these items online at http://bit.ly/in4hentr18 but you will still need to mail the $190 registration fee in order for the application to be complete. We can t wait to see you at the 2018 Indiana 4-H Entrepreneurship Academy! All the Best, Arin Weidner Indiana 4-H Youth Development arin@purdue.edu 765-494-8435 Indiana 4-H Entrepreneurship Academy Indiana 4-H Youth Development Program Agriculture Administration Building 615 W. State St. West Lafayette, IN 47907 (765) 494-8435 FAX: (765) 494-0268 fourh@four-h.purdue.edu www.extension.purdue.edu/4h Purdue University, Indiana Counties and U.S. Department of Agriculture Cooperating An equal access/equal opportunity/affirmative action university
2018 4-H Entrepreneurship Academy Registration Student Information First and last name Address City State Zip Phone E-mail (required) Current Grade Gender: Age (as of Jan 1, 2018) Birthdate (MM/DD/YYYY): Attendee requires auxiliary aids/services due to disability. Dietary, Allergy, and medical restrictions: (Please list food allergies and known medical restrictions/issues) Medical Information Medical Conditions Current Medications Date of Last Tetanus Shot Physician s Name Physician s Phone Demographic Information This information is only for federal reporting requirements. Your name will not be associated with this information in any reporting and these questions are optional. Are you currently enrolled in Indiana 4-H? Yes No If yes, please write the county in which you are enrolled: (i.e. Marion, Lake, Vigo, etc.) What is your ethnicity? Hispanic/Latino Not Hispanic/Latino What is your race? (circle ALL that apply) American Indian or Alaska Native Asian or Asian American Black or African American Native Hawaiian or Pacific Islander White Other Please mail this form and payment by May 15, 2017 to: 4-H Entrepreneurship Academy 615 W. State St. West Lafayette, IN 47907 2
2018 4-H Entrepreneurship Academy Registration Parent/Guardian Information First and last name Address City State Zip Phone E-mail (required) Emergency Contact First Contact Name Relationship to Participant Day Phone Night Phone Second Contact Name Relationship to Participant Day Phone Night Phone Registration Fee Include with this application a check payable to Purdue University for $190. The registration fee covers lodging, meals, program supplies, and insurance for the duration of the on-campus event. Please mail this form and payment by May 15, 2017 to: 4-H Entrepreneurship Academy 615 W. State St. West Lafayette, IN 47907 3
2018 4-H Entrepreneurship Academy Registration Team Participants are encouraged to assemble and attend the event as a team of no more than four (a group of friends, classmates, club members, etc.). However, if you can t assemble a team, you can register independently and we can help match you with a team. You may also choose to work independently. If you have assembled a team, please list your team members' names below. A team can have a maximum of four members (including yourself). Remember that each team member must meet eligibility requirements and register to attend. Spots will be held for your team members but if they do not completely register by May 15, their spot will be forfeited to allow those on the waiting list to attend. Please list your team members below. If you want to attend the academy, do not have a team and wish to be matched with a team, simply write "match please". If you would like to work independently, write independent 1. 3. 2. Program Components The 4-H Entrepreneurship Academy has three components: 1.At home (Now through June) Independent group work from Now-June. This is an opportunity to start researching your ideas and formulating a BIG PICTURE plan. It s important to use this time to start documenting your idea, so when you arrive in June, you will be able to utilize the time with the faculty, staff, and experts to the fullest. Once your registration information has been received, an email will be sent to the email you provide with some activities to help you kick-start your business plan. 2. June 13-15, 2018 On-campus experience at Purdue University. This is where you ll experience hands-on entrepreneurship activities, meet faculty/staff/experts, and work towards building your business pitch. 3. June 15, 2018 Final business pitch at Purdue University with the opportunity to receive feedback from experts working in the field of entrepreneurship. field of entrepreneurship of entrepreneurship Please check the box below indicating you understand the components of the Indiana 4-H Entrepreneurship Academy. Please check this box indicating you have read the program components Please mail this form and payment by May 15, 2017 to: 4-H Entrepreneurship Academy 615 W. State St. West Lafayette, IN 47907 4
KEEP THIS PAGE FOR YOUR INFORMATION Indiana 4-H Entrepreneurship Academy Application Checklist Use this checklist to make sure you submit everything necessary to attend: 300-word essay Complete registration form Team members listed and also enrolled/enrolling (unless you are registering independently) $190 registration fee (check payable to Purdue University) Everything mailed by May 15, 2018 to: 4-H Entrepreneurship Academy 615 W. State St. West Lafayette, IN 47907 Additional details about check in and program requirements will be sent after the application is received by Indiana 4-H. 5
Frequently Asked Questions KEEP THIS PAGE FOR YOUR INFORMATION 1. What will we do? The ultimate goal of the Indiana 4-H Entrepreneurship Academy is for teams to gain real-world experience and skills to create a business pitch. There will be lots of work involved for this opportunity but the pay-off could be huge! 2. Who should participate in this? Indiana high school students who have completed grades 9-12 and have a sincere interest in and passion for entrepreneurship and small business development. Teens should plan to attend with a team of three other friends, classmates, or club members. 3. What if I don t have a team? We will match you with a team at the academy or you can choose to work independently. 4. Is there a selection process? No. As long as you have completed all parts of the application, paid the registration fee, submitted them by May 15, and meet the requirements of the program you will be accepted. This is limited to 30 participants so be sure to enroll yourself and team members as soon as possible. 5. Does every team member have to be a member of Indiana 4-H? No. 6. Do I have to participate as part of a team? No. Although, participating as a team will make the business pitch stronger and provide a better realworld experience. 7. Does my team need to prepare anything ahead of time? Yes. It will be helpful if your team can come to the on-campus orientation in June with a few product/business ideas in mind. This will give you a jump start and make the best use of your time at the Academy. Think about big ideas that fill a need and can have impact in your local community or region. This is your chance to potentially have a big impact in your hometown! Additional details about this will be provided after your application is received. 8. How much does it cost to participate? There is a one-time registration fee of $190 per participant. This covers all meals and lodging while at Purdue University, insurance, and program materials and supplies. 9. I still have more questions. Who can I call? Contact Arin Weidner at 765-494-8435 or arin@purdue.edu 6