North Carolina 4-H Name & Emblem Application
Groups and or Clubs seeking to use the 4-H Name and Emblem must complete and submit this application. Upon approval by county Extension staff, permission will be given.  This application expires 1 year from the date of application approval.
Sign in to Google to save your progress. Learn more
Email *
I have read and understand the 4-H Name and Emblem User Guide for non-Extension Entities *
Required
Type of Group *
Name of Group *
Name of Volunteer Leader and Primary Contact *
Volunteer Leader Mailing Address *
Goal & Objective of group applying for 4-H Name and Emblem use: *
Date(s) & Time(s) of Meetings *
Example: Third Saturdays of each month.
Please describe how the clover will be used: *
Will your group be handling funds? *
Groups handling funds must designate one adult volunteer to be responsible for fund management.  Groups handling funds must also work with the county 4-H professional in accordance with NC 4-H guidelines found in the NC 4-H Treasurers Guidebook.  Groups must register annually to maintain the use of the 4-H name and emblem.
To be completed by the Extension Office:
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of North Carolina State University. Report Abuse
Google Forms