Complete the following Waupaca County application for Space Camp. An interview process may be held if needed. This appli
Waupaca County U.S. Space Camp Application Complete the following Waupaca County application for Space Camp. An interview process may be held if needed. This application form is due in the UW-Extension Office on or before November 1st . Name______________________________________ Male or Female________________ Your age on January 1 this year___________________ Date of Birth_____/_____/_____ Current Grade Level___________________ Phone (____) ________________________ Address_________________________________________________________________ ________________________________________________________________________ Club___________________________________ Year in 4-H _____ (including this year) Have you worked in the 4-H Foodstand at County Fair?
YES
Are you or have you been enrolled in a 4-H aerospace project?
NO YES
NO
Why would you like to attend Space Camp?
How do you plan to share your experience when you return from your trip?
--OVER--
List your other 4-H activities during the last year (club officer, camp, Super Saturday, community service, etc.). Year
Activity
Describe below your favorite 4-H project or 4-H activity. 4-H Project or 4-H Activity: _____________________________________ ·
How long have you been involved in this project or activity?
·
Explain what you have done for this project or activity.
·
Why is this your favorite?
Member signature: ______________________________ Parent signature:________________________ General Leader signature: _________________________________ Date: ________________________ Due to the UW-Extension Office by November 1st . Form updated September 2014
