4-H Tech Changemakers Application
Scotland County 4-H is pleased to invite you to join the North Carolina 4-H Tech Changemakers team by completing the application. Put N/A for sections that do not pertain to you. If you are between the ages of 13-18, you can become a Scotland County 4-H Tech Changemaker.

A required training will be held via Zoom on Monday, September 26th AND Tuesday, September 27, 2022 6:00 PM - 8:00 PM.
For more information about 4-H Tech Changemakers, click the link or call (910) 277-2422.
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First Name *
Last Name *
Home Phone (  ) xxx-xxxx *
Cell Phone (  ) xxx-xxxx *
Address *
City, State, Zip *
Email Address *
Date of Birth *
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DD
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YYYY
Grade (2022-2023) *
School Attending *
Parent/Guardian's First and Last Name *
Parent/Guardian's First and Last Name *
Parent/Guardian's Phone *
Parent/Guardian's Phone *
List any leadership activities (volunteer experience, church and school activities, groups, clubs, community organizations, etc.) in which you are now involved in or have been involved in within the last three years. *
Of the past three to four years, list any honors, awards, or special recognition you have received either in school or in the community. *
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