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June Dairy Month County Chairperson Application & Resume DEADLINE: April 26, 2019

COUNTY: __________________ MEDIA DIVISION*: __________

4-H CLUB MEMBER CHAIRPERSON

NAME: _______________________ SHIRT SIZE: Adult Polo

SHIPPING ADDRESS: ________________________________________________________

CITY/ST/ZIP: ________________________________________________________

EMAIL: _______________________ PHONE: _______________________

4-H EXTENSION AGENT

NAME: ________________________________________________________

MAILING ADDRESS: ________________________________________________________

SHIPPING ADDRESS: ________________________________________________________

CITY/ST/ZIP: ________________________________________________________

EMAIL: _______________________ PHONE: _______________________

Please return this form, resume and a headshot photo** to:

The Dairy Alliance

Ashley Buice

Email: abuice@thedairyalliance.com

Fax: 770.996.6925

Questions? Call: 800.343.4693 Or Mail to: 5340 West Fayetteville Road, Atlanta, GA 30349

*Media Divisions are based on individual county’s opportunities for

media exposure. Each county chairperson’s activities will be judged

against only those counties in their designated group. Only radio

stations or newspapers based in your county can be used (P

**Headshot photo and application will be used for press releases in

the appropriate county.

June Dairy Month County Chairperson Application & Resume DEADLINE: April 26, 2019

NAME: COUNTY

PARENTS:

SIBLINGS:

________________________________________________________

AGE: GRADE: SCHOOL:

LOCAL

NEWSPAPER(S):

________________________________________________________

________________________________________________________

4-H PROJECT

AREAS

________________________________________________________

________________________________________________________

What

events/contests

have you

participated in

through 4-H?

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

Please list any 4-H

awards:

________________________________________________________

________________________________________________________

________________________________________________________

What do you do

outside of 4H?

(please list

organization,

school or church)

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

Please list any

awards outside of

4-H:

________________________________________________________

________________________________________________________

________________________________________________________

Why did you want

to become June

Dairy Month

chairman?

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

Why are you

passionate about

the dairy industry?

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

Please write one or

two sentences

about what being

June Dairy Month

chairman means to

you:

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

June Dairy Month County Chairperson Application & Resume DEADLINE: April 26, 2019

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Division I – Counties with no more than 2 media outlets

Bedford

Benton

Bledsoe

Bradley

Cannon

Carter

Cheatham

Chester

Clay

Crockett

Decatur

Dekalb

Fayette

Grainger

Greene

Grundy

Hancock

Haywood

Henderson

Hickman

Houston

Humphreys

Jackson

Jefferson

Johnson

Lake

Lewis

Loudon

McNairy

Meigs

Monroe

Moore

Morgan

Perry

Pickett

Polk

Rhea

Roane

Robertson

Sequatchie

Smith

Stewart

Tipton

Trousdale

Unicoi

Union

Van Buren

Wayne

Weakley

White

Division II – Counties with 3 to 4 media outlets

Anderson

Blount

Campbell

Carroll

Cocke

Claiborne

Cumberland

Dickson

Dyer

Fentress

Franklin

Giles

Hamblen

Hardeman

Hardin

Hawkins

Henry

Lauderdale

Lawrence

Lincoln

Macon

Marion

Marshall

Maury

McMinn

Montgomery

Obion

Overton

Putnam

Rutherford

Scott

Sevier

Warren

Division III – Counties with 5 or more media outlets

Coffee

Davidson

Gibson

Hamilton

Knox

Madison

Shelby

Sullivan

Sumner

Washington

Williamson

Wilson

June Dairy Month County Chairperson Summary Report Please print legibly and submit inside front cover of scrapbooks. All items due by July 31.

COUNTY: __________________ MEDIA DIVISION*: __________

CHAIRPERSON: ________________________________

Please list the name of the specific type of media used for your different dairy promotions, along with a brief description

of the event. List radio and tv stations by call letters or name, social media by URLs, newspapers by name etc.

Media

Reference/Station Description of Dairy Promotion

Please write a short summary of other activities you participated in, which shows how you involved other 4-H members in

the promotion of dairy:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________ Please write a short summary of how you used this year’s theme in the promotion of dairy:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

USE THIS PAGE ONLY. DO NOT ATTACH ADDITIONAL PAGES. THIS FORM IS A SUMMARY.

____________________________________________

4-H Extension Agent Signature Date