Portage County 4-H Adult Ag Leader of the Year Nomination Form
This form must be submitted by January 27, 2023


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Name of Nominator (Your Name) *
You are welcome to nominate yourself!
Name of Adult You Are Nominating *
Club of Adult Nominee *
If not affiliated with a club or unknown, select "N/A"
Years as a 4-H Leader
If unknown, leave blank
4-H Leadership related to Agriculture *
Give a general description of the adult nominee's activities in a few sentences.
Recommendation *
Your personal recommendation of the adult nominee (i.e. why do they deserve the award?). Please include at least a few sentences.
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