Provincial Opportunities Agri-Career Quest (ACQ) Target Audience: 16-22 year olds (by midnight Dec 31 st previous yr) Opportunity Date: May 4-9, 2017 Location: Begin and end in Abbotsford Registration Fee: $300 (Registration fee includes: all cost of accommodation, food & program beginning from Abbotsford May 4-9 inclusive. Arrangement of travel to and from Abbotsford is the responsibility of the delegate, however reimbursement is available post program based on 21 day advanced bus fare purchase.) No. of Delegates: 38 This experience is a six day program for 4-H members and non 4-H students to explore careers in the agriculture industry. Most of the program takes place on a charter bus to allow for agriculture tour stops in different regions of BC. Participants will get to see and experience first-hand the diversity of agriculture in BC and the careers available in the industry. There is a career building component where participants learn how to market themselves through resume, interview and networking skills. For information about Agri-Career Quest 2015, visit the trip s blog at http://agricareerquest.wordpress.com/. The program is also open to non 4-H members of the appropriate age with an interest in agriculture. Applications for non 4-H members are available at www.bc4h.bc.ca. Eligibility: Must have Achieved 2 years in 4-H Must be enrolled in current 4-H year Must possess a Junior Proficiency Certificate Travel Opportunities: Selection will take place at the end of Agri-Career Quest 2017. All 4-H participants at Agri-Career Quest are eligible for travel Opportunities Selections (page 7) unless they have received a travel opportunity from Provincial 4-H Club Week or previous participation in Agri-Career Quest. 4-H members can attend both Agri- Career Quest and Provincial Club Week programs, but are only eligible for one travel opportunity from either of those programs. Application Requirements: 4-H BC Application: Section 1: Program Application, Section 3: Member Information and Section 5: 4-H Club Leader s Evaluation Copy of completed and signed 4-H Member-Parent Release Form (page 33-35) Applicant s Photo (used for identification purposes) Registration Fee payable to 4-H BC Sponsors: 4-H BC Provincial Council, B.C. 4-H Foundation, BC Ministry of Agriculture, WestGen, Kubota, Government of Canada Submit your completed application to your District Key Leader by the District/Regional Deadline dates. Agri-Career Quest was a truly eye opening experience. I learned about the vast variety of agricultural careers available in BC and how to find the path to any career that I am interested. Hilary, 2015 Agri-Career Quest Delegate 4
Application Instructions If you need another copy of these forms, please photocopy as needed. Be honest and as accurate as possible and read each question carefully before answering. If you have any questions ask your Leader, Key Leader or contact the 4-H BC Office. Agri-Career Quest, Youth Action, and 4-H BC Ambassadors: Fill out Section 1: Program Application and Section 3: Member Application. Have your leader to fill out Section 5: 4-H Club Leader s Evaluation. Have your Parent or Guardian fill out the 4-H Member - Parent Release Form (page 33-35) and send in with your application. Remember to include your photo and the registration fee made payable to 4-H BC. 4-H BC Provincial Communication Finals Application (Public Speaking and Demonstration): Fill out Section 4: 4-H BC Communication Finals Application Have your leader to fill out Section 5: 4-H Club Leader s Evaluation. Have your Parent or Guardian fill out the 4-H Member - Parent Release Form (page 33-35) and send in with your application. Make all Registrations Remember to include your photo and registration fee made payable to Fees payable to 4-H BC. 4-H BC Scholarship Application: Fill out Section 2: Scholarship Application. Have your leader sign your application. Include your school transcripts, reference letters, and budget. Include Provincial and National 4-H scholarship essay or visual presentation as required. Check with your District Council, your Key Leader or visit www.bc4h.bc.ca for more information. Leader, Volunteer and Alumni Application: Complete Section 6: Leader, Volunteer and Alumni Application. Remember to include your opportunity preference. EMAIL ACCOUNTS included in applications should be active accounts and checked regularly by applicant. PLEASE USE YOUR FULL NAME THAT SHOWS ON YOUR TRAVEL I.D. AS THIS INFORMATION IS VERY IMPORTANT FOR AIRLINE TICKETS! IMPORTANT All age requirements in this guide relate to the age of the member at midnight of December 31 st or the previous year. For example, a member applying to an opportunity in 2017 with an age requirement of 14, must have turned 14 by midnight December 31, 2016. 4-H Members are expected to participate in the entire Opportunity (e.g. Agri-Career Quest, Youth Action, Provincial Communication Finals etc.). If for some reason this is not possible, please inform the 4-H BC Office, and allow someone else to fill your position. 16
INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED PLEASE ENSURE YOU HAVE COMPLETED THE FOLLOWING CHECKLIST PRIOR TO SUBMITTING YOUR APPLICATION: Checklist o I have read all information related to the opportunity for which I am applying. o I have legibly completed the Application Form. o I have included an email address for an account that is active and checked regularly o I have included all additional pages necessary, including references, evaluations or cover letter, picture etc. o I have included my cheque for registration fees, made payable to 4-H BC Provincial Council. o I have answered essay questions and attached them to the Application Form, where applicable. o I have mailed my Application Form and materials to the correct location allowing adequate time so that the application package arrives before the deadline. 17
1: Section Section 1: Program Application Electronically filled or neatly handwritten applications will be accepted. 4-H BC collects personal information, following the Personal Information Protection Act (PIPA) regulations, for the purpose of establishing relationships with our members, leaders, and any other stakeholder to deliver 4-H programs, services and opportunities as well as for statistical and archival purposes. By completing this document voluntarily, you are consenting to 4-H BC collecting, using and distributing your personal information in accordance with PIPA for the operational and business purposes of 4-H BC. By opting out of providing your personal information, this may limit or eliminate altogether the organization s ability to provide products and/or services to you, to involve you in other organizational activities and/or to communicate with you. You may withdraw your consent at any time by contacting the 4-H BC Privacy Officer at manager@bc4h.bc.ca or at 1-866-776-0373. Name of Opportunity to which you are applying: Name (as it appears on your ID): Mailing Address: City Postal Code Home Phone Number M or F Name of 4-H Club: Age at midnight Dec 31 st of previous year Birthdate (dd/mm/year) No. Years Achieved in 4-H: # of Members Attach Photo Here (for identification purposes) TAPE ONLY! Please do not tape across TOP of Photo. NO GLUE! Maximum size 2 x 2.5 (5cm x 6.35cm) Email to receive program information: Closest Greyhound Bus Depot to your home: a) 4-H Club Participation (consult your Personal Record Book). If in two clubs, total for the year. Year 1 Year 2 Year 3 Year 4 Year 5 Total Most Recent 5 years of 4-H Number of meetings held by your club(s) Number of those meetings you attended b) 4-H Offices and Committee Positions. Fill in the years that you held the position and indicate beside the year the number of members in your club. Position Years (e.g. 2016) Total Years (#) President Vice-President Secretary Treasurer Reporter Safety Officer c) Leadership Project Completion. Projects Years No. of Club Members Specific Responsibilities Junior Leadership Senior Management Self-Determined d) Indicate any 4-H Committees you have been on during the Last three years, the Committee name and your responsibilities: Continued on page 20 19
e) Opportunity Participation: Indicate your participation in Public Speaking, Demonstrations, Educational Displays, Speak & Show, Judging and Provincial Opportunities (PCW, YA, Food For Thought, Agri-Career Quest), etc. Include whether it was club (c), district (d), region (r) or provincial (p). Attach additional pages if more space is required. Year Event and Level Details f) Non 4-H Activities: List activities other than 4-H, including community, church, school, sports, hobbies. Year Details 20
Section 3: Member Information Living Location (circle one): Size of Family (#): Farm Urban Rural (Non-Farm) Sisters: Brothers: Delegate s Previous Travel Opportunities: School Trips: Other (family, on own, etc.): a) Project Record: List your 4-H Projects that you achieved in starting with your 1st year 4-H project, up to and including this year s project. Year Project(s) (i.e. horse, beef, etc.} Unit b) Explain briefly what you feel you have learned from your project work that has assisted you as a person. c) Non-competitive 4-H Awards: List 4-H Badges, Jr. Proficiency and Senior Skill Certificate, Project Pin, Honour Pin, Grade 11/12 Credit, Continued on page 26 25
d) 4-H Activities: List Fund-raising events, 4-H Promotions, Radio and T.V. Appearances, Newspaper Reports, Community Improvement Projects, Special Events, etc. Year Event and Level Details Member Self Evaluation Please give an honest and critical evaluation of yourself as a 4-H member. Information must be in Member s own handwriting or printing. I feel that I should attend (opportunity) because: Promotional Consent Release: As custodial parent and/or guardian of the above 4-H member, I hereby permit the 4-H BC Provincial Council to use any photo, audio, digital, electronic or video recording with or without the name of this member in any 4-H print, electronic or audiovisual information in their entirety or portions thereof for the purpose of 4-H Program awareness and/or promotion within the 4-H organization or to the general public. Please contact the 4-H BC Privacy Officer at manager@bc4h.bc.ca or at 1-866-776-0373 if you have any questions about this release. Signature of Parent / Guardian: Statement by Club Member: I have personally prepared this report and believe it to be correct. Date: Signature of Member: Approval of this Application: I have reviewed this report and believe it to be correct. Signature of Parent / Guardian: 26
Section 5: 4-H Club Leader s Evaluation 4-H BC collects personal information, following the Personal Information Protection Act (PIPA) regulations, for the purpose of establishing relationships with our members, leaders, and any other stakeholder to deliver 4-H programs, services and opportunities as well as for statistical and archival purposes. By completing this document voluntarily, you are consenting to 4-H BC collecting, using and distributing your personal information in accordance with PIPA for the operational and business purposes of 4-H BC. By opting out of providing your personal information, this may limit or eliminate altogether the organization s ability to provide products and/or services to you, to involve you in other organizational activities and/or to communicate with you. You may withdraw your consent at any time by contacting the 4-H BC Privacy Officer at manager@bc4h.bc.ca or at 1-866-776-0373. Please provide an honest and critical evaluation of the applicant. Consider the member s attitude at club meetings and functions, willingness to help fellow members, outside 4-H community involvement, maturity away from home and leadership skills. Leader evaluation may not be completed by a family member or parent. 4-H Member s Name Club 4-H Leader s Name I have known the above 4-H Member for years. I (Please Circle One) the above member to attend a 4-H opportunity. Recommend Do Not Recommend Am Doubtful in Recommending 1. What is your overall impression of this 4-H member? 2. Does this member attend club meetings and activities regularly? 3. What contributions has he/she made to your 4-H club? (Please describe in detail). 4. Please comment on the quality and general attitude towards project work. 5. How does this 4-H member get along in a group with his/her peers? Note to Leader: The above information is requested to assist the review panel in making their selection. The evaluation may be submitted with the application or directly to the review panel. The information is confidential and will not be returned to the delegate. Leader Signature: Date: Leader Signature: 29
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MEMBER PARENT RELEASE FORM Publication #135 Version: 09/15 4-H BC collects personal information, following the Personal Information Protection Act (PIPA) regulations, for the purpose of establishing relationships with our members, leaders, and any other stakeholder to deliver 4-H programs, services and opportunities as well as for statistical and archival purposes. By completing this document voluntarily, you are consenting to 4-H BC collecting, using and distributing your personal information in accordance with PIPA for the operational and business purposes of 4-H BC. By opting out of providing your personal information, this may limit or eliminate altogether the organization s ability to provide products and/or services to you, to involve you in other organizational activities and/or to communicate with you. You may withdraw your consent at any time by contacting the 4-H BC Privacy Officer at manager@bc4h.bc.ca or at 1-866-776-0373. I, (parent name) am the (parent/guardian) of (4-H member) member of (club name) and certify that he/she has my permission to participate in the 4-H program/opportunity as a The staff and volunteers of the 4-H program provide the best educational program possible. However, the success of the program is equally dependent on the 4-H member assuming mature, responsible and safe behaviour while in attendance. The standards of behaviour include the following rules: 1. Possession or use of alcoholic and/or illegal drugs is absolutely prohibited. 2. No 4-H member may leave the grounds without permission of a 4-H program staff member/leader/chaperone. 3. Co-ed visiting during non-designated times is not permitted. 4. Members are expected to behave at all times in a manner consistent with the educational purposes of the program. 5. The programs are not without risk and members, in dealing with livestock or otherwise, are expected at all times to follow instructions, and to carry on in a safe manner. 6. Pre-arranged travel plans to and from the 4-H program/opportunity must be adhered to unless alternate arrangements have been authorized. THOSE 4-H MEMBERS WHO DO NOT MAINTAIN THESE STANDARDS SHALL FORFEIT THE PRIVILEGE OF ATTENDING THIS 4-H OPPORTUNITY/PROGRAM AND RETURN HOME AT THEIR OWN COST, AND BE CHARGED IN FULL FOR THEIR PORTION OF ROOM AND BOARD. I agree that the participation of (member s name) is entirely at his/her own risk. This program/opportunity is of a strenuous nature both physically and mentally and it is in the interest of the member s well-being that the following information is being requested. Legal name of member: Address: Postal Code: Date of Birth: In Emergency notify: Address: Postal Code: Cell Phone: Surname First Middle Home phone: Month/day/year Relationship: Home Phone: Business Phone: Doctor s Name: Address: Member s Health Care Number: Other Hospital Insurance: Business Phone: 33
MEDICAL HISTORY PLEASE CIRCLE EITHER YES OR NO TO INDICATE MEDICAL CONDITION A. Is the member s immunizations up to date? Yes No If no, state reason: When was member s last tetanus inoculation? B. Is there a history of any of the following: asthma fainting spells convulsions heart problems diabetes epilepsy lung problems any other problems, please explain: C. Does the member have any allergies? Yes No Name all allergies (e.g. medications/foods/plants/animals/environmental etc.): D. Does member take any medications? Yes No NAME OF MEDICATION REASON DOSAGE TIMES E. Does the member have any difficulties with any of the following? Eyes Yes No Remarks: Does member wear glasses? Yes No Contact Lens Yes No Denture Plate Yes No Ears Yes No Remarks: Nose Yes No Remarks: Throat Yes No Remarks: Digestion Yes No Remarks: Sleepwalking Yes No Remarks: Any other difficulties? Yes No Remarks: If yes, explain F. Are there any physical activity restrictions? Yes No If yes, please list and explain: G. Is member on a Special Diet? Yes No If yes, please explain what kind: 4-H Members attending Provincial 4-H residential opportunities/conferences may request special diets three weeks prior to program/opportunity commencing. E.g. Provincial Club Week, Agri-Career Quest, Youth Action, Food For Thought, Provincial Communication Finals Mail to: 4-H BC, 2743-30 th Street, Vernon, BC V1T 5C6 Fax: 250-545-0339 Signature of Parent/Guardian Date I have read and understand this 4-H BC member-parent release form. I agree that I participate voluntarily upon the basis of its term. Signature of 4-H Member Date 34
MEDICAL TREATMENT RELEASE FORM I, as the parent or guardian under circumstances as stated below, hereby Authorize the staff person/chaperone/leader in charge of the program to secure such medical advice and treatment as may be deemed necessary for the health and safety of my child or ward, And I agree to accept complete financial responsibility in excess of the benefits allowed by the Provincial Health Plan: 1. Where the health and well-being of my child/ward is involved. 2. Where medical advice has been such that further services are required services which require the consent of the parent or guardian. 3. Where all attempts to contact the parent or guardian have failed or where due to the nature of the emergency there is insufficient time to contact such parent or guardian, it will be at the discretion of the staff member/chaperone/leader in charge of the program as to what steps must be taken for the welfare and safety of my child/ward. Dated at in the Province of this day of, 20. Signature of Parent or Guardian 35