TERRY COOPER UNSUNG HERO AWARD

Nomination form

Deadline for Submission: December 1, 2009

NAME OF NOMINEE: __________________________________

ADDRESS: ____________________________________________

Please check which award applies to this nominee:

Adult________ Youth_________

I. What activities has this person been involved with to better the 4-H experience in your Club? How long and how often? Please be specific.

II. What does this person do at a county, state or national level to support and promote the 4-H program, If so, for how long and how often? Please be specific.

Please mail to:    A.A. County 4-H Foundation

7320 Ritchie Hwy, Suite 210

Glen Burnie MD 21061

Applications postmarked after the deadline will not be accepted.

PLEASE ADD ADDIIONAL PAGES IF NEEDED AND PLACE NOMINEE’S NAME AT THE TOPE OF EACH PAGE.

“It is the policy of the University of Maryland, Agricultural Experiment Station and Maryland Cooperative Extension, that no person shall be subjected to discrimination on the grounds of race, color, gender, religion, national origin, sexual orientation, age, marital or parental status or disability.”