Teen Influencers for Equity & Inclusion

Name in 4-H records *

First Name Last Name

Name you are known by (if different)

First Name Last Name

Age *

Grade in School *

County *

Email *

example@example.com

Phone Number *

Area Code Phone Number

Parent/Guardian Name *

First Name Last Name

Parent/Guardian Email *

example@example.com

Parent/Guardian Phone Number *

Area Code Phone Number

Are you a current 4-H member? *

YES NO

Carefully read the requirements detailed on the Teen Equity Ambassador Webpage and in the Call for Applications Document by visiting the provided links to ensure you able to commit to the expectations of this leadership role, then check the box below.

*

By checking this box, I am indicating that I have read the qualifications and criteria for serving in this role and am able to perform the duties as outlined on the Teen Influencer Webpage and in the Call for Applications Document. I am committed to promoting diversity, equity and inclusion within 4-H.

Teen Influencers will:

Serve as liaison between 4-H members and their Champion Group.
Represent a broad range of youth voices in their Champion Group work.
Participate in the planning, development, and facilitation of their Champion Group’s initiatives and programs.
Collaborate with other Teen Influencers to enhance the work between Champion Groups.

Describe below any skills and/or knowledge that will help you take on the responsibilities stated above. *

Why would serving as a Teen Influencer be a meaningful experience for you? *

Teen Influencers will be selected for the following Champion Groups listed below.

Rank the group(s) for which you would like to be considered, with 1 being your first choice.If you are interested in only one group, mark that group with a “1” and leave the rest blank. Selection of multiple groups is not required and will not impact your chances of being selected.

Youth Living with Disabilities

Youth Living in Foster Care

Immigrant, Refugee, Racial/Ethnic Youth

LGBTQ+ Youth

Youth Mental Health and Well-being

Describe what access, equity, & inclusion mean to you in relation to the Champion Group(s) from above that you wish to serve. *

How do you think 4-H youth programs could be better in areas of diversity, equity and inclusion in relation to the Champion Group(s) from above that you wish to serve? *

Is there any other information you think we should have about your interest in becoming a Teen Influencer?

References

Please provide contact information for a non-family adult reference who can speak to your eligibility for the Teen Influencer position in general and your motivation/skills for working with the Champion Group(s) in which you are interested, specifically. Once you submit your application, your reference will be emailed a message asking them to provide an online recommendation. If you haven’t already shared your interest in the Teen Influencer position with them, please let them know to expect that message from Iowa 4-H Youth Development.

Reference Name *

First Name Last Name

Email *

example@example.com

Phone Number (will be used only to follow up on email issues) *

Area Code Phone Number

Program Expectations

Teen Influencers will:

Serve as liaison between 4-H members and their Champion Group
Represent a broad range of youth voices in their Champion Group work
Attend monthly scheduled Champion Group meetings (in person or virtually)
Participate in the planning, development, and facilitation of their Champion Group’s initiatives and programs
Collaborate with other Teen Influencers to enhance the work between Champion Groups
Attend meetings and training as necessary
Utilize email as the primary form of contact with their Champion Group.

Applicants Must:

Be in grade 7-11 at the time of application
Demonstrate motivation, skills, experience, and/or knowledge in contributing to access, equity, & inclusion for youth in Iowa 4-H programming
Be a 4-H member during their service as a Teen Equity Ambassador.

I have read the program expectations above. *

By checking this box, I agree could uphold these responsibilities if I am selected as a Teen Influencer for Equity & Inclusion.

Youth Signature *

Clear

Parent/Guardian Signature *

Clear