Name:

Birth date:

Age as of January 1, 2005:

(Note: You must be at least 15 but not more than 18 years of age as of January 1, 2005 to be considered for this conference)

County:

Mailing Address:

Telephone Number: (     )

Social Security Number:

Name and telephone number of your 4-H agent:
 
 

Please answer the following 6 questions fully and in your own words. You may attach additional pages.
 

1. Are you enrolled as a 4-H member in North Carolina? Yes     No
 
 

2. How many years have you participated in dairy youth activities?
 
 

3. List all of the dairy and dairy youth activities in which you have participated.
 
 

4. Describe what you think the dairy industry in North Carolina will be like in 10 years.
 
 

5. Describe your future educational and career plans.
 
 

6. Why would you like to be selected to attend the National Dairy Youth Conference?
 

Please send this completed application by Tuesday, May 31, 2005 to:

By mail:
Dr. Brinton Hopkins
Department of Animal Science
108-B Polk Hall
Box 7621
North Carolina State University
Raleigh, NC 27695-7621
 

or by fax:
919-515-2152