╨╧рб▒с>■  ,.■   +                                                                                                                                                                                                                                                                                                                                                                                                                                                ье┴q ┐Zbjbjt+t+ R$AAZ      ]$$$$$$ 0,$E ╢ppppppppFHHHDМ└L└ $√ Їя v0 ppppp0 дpppдддp4ppF$$pFдвдFFp\`╒EЗЕF┴$$дFChet and Lucy Black 4-H Professional Development Scholarship * About the Award: The Chet and Lucy Black 4-H Professional Development Scholarship has been established by Director Emeritus Dr. Chester Black and his wife Lucy to further the profession of a 4-H youth program assistant or associate, 4-H agent, or 4-H specialist. A monetary scholarship of $500 will be given to the recipient to attend a professional development experience that will enhance the recipientsТ ability to perform their job responsibilities. (see attached description for more details) All employees of the Cooperative Extension Service whose major job responsibility is 4-H youth development work are encouraged to apply. Submit to: Dr. Mike Davis Associate Director Box 7606, NCSU Raleigh, NC 27695-7606 Application Deadline: Must be Received in State 4-H Office by Ocbober 22, 2001 APPLICATION FOR THE CHET AND LUCY BLACK 4-H PROFESSIONAL DEVELOPMENT SCHOLARSHIP AWARD NAME ____________________________ JOB TITLE_______________________________ OFFICE ADDRESS_____________________________________________________________ OFFICE TELEPHONE ________________ CO./DEPT.(if appl.)_____________________ I. POST-SECONDARY EDUCATION EXPERIENCE: Date Major Area(s) of Study Institution Degree ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ II. EMPLOYMENT HISTORY WITH N. C. COOPERATIVE EXTENSION SERVICE: Date Job Title Location ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ III. REFERENCES FROM WHOM LETTERS HAVE BEEN REQUESTED: (Please select references who can speak to your work as a professional within the 4-H Youth Development Program. One of the three must be a person having oversight responsibility for your work. Please place a check by the supervisorТs name) Name ____________________ Job Title Address _________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ IV. DESCRIBE YOUR CURRENT RESPONSIBILITIES WITH THE NORTH CAROLINA COOPERATIVE EXTENSION SERVICE THAT SUPPORT THE 4-H YOUTH DEVELOPMENT PROGRAM: V. DESCRIBE PROFESSIONAL DEVELOPMENT ACTIVITIES WHICH YOU HAVE UNDERTAKEN IN THE LAST FIVE YEARS: VI. DESCRIBE PROFESSIONAL ACCOMPLISHMENTS, AWARDS (IF ANY), AND OTHER EVIDENCE OF PROFESSIONAL COMMITMENT WITHIN THE LAST FIVE YEAR. VII. DESCRIBE YOUR PLAN FOR PROFESSIONAL DEVELOPMENT TO BE CARRIED OUT WITH THE AID OF THE SCHOLARSHIP AWARD. PLEASE INCLUDE YOUR PROFESSIONAL GOALS, THE NATURE OF THE DEVELOPMENT ACTIVITY, THE TIME PERIOD IN WHICH IT WOULD BE UNDERTAKEN, A COST ESTIMATE FOR THE ACTIVITY PLANNED, AND THE EXPECTED CONTRIBUTION OF THE ACTIVITY TO YOUR GOALS TO THE NORTH CAROLINA 4-H YOUTH DEVELOPMENT PROGRAM AND TO THE NORTH CAROLINA COOPERATIVE EXTENSION SERVICE: Date Submitted: __________________________________________________________ (Signature) Application Deadline: October 22, 2001 |╓ц1 \ з  r 1YZ¤√√√¤>*5Б ?@A┐└у·)*+z{О╒╓"#op╝╜хц2 3 ¤¤√√√√ўўўє√√√эцу√√√√√√√√√√$$ ╞ ╞Д Дp?@A┐└у·)*+z{О╒╓"#op╝╜хц2 3  А ╠ ═   [ \ и й ї Ў B C П Р ▄ ▌    r s ┐ └  Z[\эюяЁёЄєЇїЎў°∙·√№_`abcdefghiя╡╢╖╕╣║╗╝╜╛┐└┴┬├¤¤√c3  А ╠ ═   [ \ и й ї Ў B C П Р ▄ ▌    r s ┐ └  Z[¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤∙¤¤¤¤¤¤¤¤¤Д╨[\эюяЁёЄєЇїЎў°∙·√№_`abcdefghiя¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤яЁёЄ╡╢╖╕╣║╗╝╜╛┐└┴┬├─┼╞╟╚╔╩╦╠═¤¤¤є¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤ Д╨Д0¤ ╞`·├─┼╞╟╚╔╩╦╠═╬╧╨╤╥╙╘╒╓╫#/0Z═╬╧╨╤╥╙╘╒╓╫#/0Z¤¤¤¤¤¤¤¤¤¤¤∙¤є ╞Д '0P░╨/ ░р=!░╨"░╨#Р╨$Ра%░░а'0P░╨/ ░р=!░╨"░╨#Р╨$Ра%░░а [4@ё 4Normal1$CJhmH nH <A@Є б<Default Paragraph Font4&@Є ё4Footnote Reference&>@&Title$5БЁ Z$    )$    Z 3 [я═Z ├Z VZipад\   NCCES User/C:\WTSRV\Profiles\saray\Desktop\application.docsrowland/C:\My Documents\blackawardforms\application.docsrowland,C:\TEMP\AutoRecovery save of application.asdsrowland,C:\TEMP\AutoRecovery save of application.asdsrowland4C:\My Documents\blackawardforms\blackapplication.doc NCCES User$M:\Personal\Chetblackapplication.doc @HP LaserJet 4000 (200)Ne11:winspoolHP LaserJet 4000 Series PCL 6HP LaserJet 4000 (200)Ь$wъ odXXLetterX$JAPDdTimes New RomanH X HP LaserJet 4000 (200)Ь$wъ odXXLetterX$JAPDdTimes New RomanH X Аа,щЖZP@GРЗЯTimes New Roman5РАSymbol3&Р ЗЯArial"AИ ╨h╥Yf╥Yfo╠YF╒ ! 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